Thalidomide treatment in myelofibrosis with myeloid metaplasia

Michelle A. Elliott, Ruben A. Mesa, Chin Yang Li, C. Christopher Hook, Stephen M. Ansell, Ralph M. Levitt, Susan M. Geyer, Ayalew Tefferi

Research output: Contribution to journalArticle

108 Scopus citations

Abstract

Myelofibrosis with myeloid metaplasia (MMM) is uniquely characterized by macroscopic bone marrow stromal changes that are believed to be both reactive and cytokine mediated. Furthermore, a prognostically detrimental increase in bone marrow angiogenesis has recently been demonstrated. These observations suggest a potential therapeutic role for agents that are inhibitory to angiogenesis as well as cytokines that are pathogenetically implicated in MMM. In a prospective study of 15 patients with MMM, thalidomide treatment, starting at a dose of 200 mg/d, resulted in increased platelet counts (12 of 15 patients), increased haemoglobin level (3 of 15), a modest decrease in spleen size (3 of 12), increased bone marrow megakaryopoiesis (5 of 9) and decreased bone marrow angiogenesis (2 of 9). Undesirable haematological effects included pericardial extramedullary haematopoiesis in one patient, marked leucocytosis in two patients and extreme thrombocytosis in three patients. The thrombocytosis occurred in both patients with post-thrombocythaemic myeloid metaplasia (PTMM) and was also associated with higher baseline levels of circulating CD34+ cells. Previously described toxicities of thalidomide were seen in the majority of patients and dose escalation to 400 mg/d was permitted in only two patients. In contrast, toxicity-related dose reductions to 50 mg/d did not appear to lessen drug efficacy. We conclude that thalidomide has both beneficial and potentially adverse biological activity in MMM. A lower dose of the drug might be more tolerable without compromising therapeutic value. Patients with PTMM and/or markedly increased circulating CD34+ cell counts might be susceptible to thalidomide-induced thrombocytosis.

Original languageEnglish (US)
Pages (from-to)288-296
Number of pages9
JournalBritish journal of haematology
Volume117
Issue number2
DOIs
StatePublished - May 8 2002

Keywords

  • Bone marrow angiogenesis
  • Chronic myeloproliferative disorders
  • Extramedullary haematopoiesis
  • Myelofibrosis with myeloid metaplasia
  • Thalidomide

ASJC Scopus subject areas

  • Hematology

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