Low dose thalidomide as maintenance in multiple myeloma

Autologous hematopoietic stem cell transplantation [ASCT] following chemotherapy improves survival and decrease relapse rate in patients with multiple myeloma. However, patients not eligible for ASCT relapse earlier demanding search for new treatment modalities. was to evaluate the effect of low dose thalidomide as maintenance therapy in patients attaining a complete remission after chemotherapy and who not candidates for autologous stem cell transplantation. This study was carried out on a total of 92 patients randomized in two groups, group I [arm A] [44 patients] received 50 mg thalidomide daily and group II [arm B] [48 patients] did not receive any maintenance treatment the follow up period was 40 months. Median age for group I was 66 years and 68 years for group II Male to female ratio was 3:1 for both groups. Regarding the types of myeloma; IgG kappa myloma represented 70% of cases in group I and 75% of group II, IgG lambda constituted 20% and 19% in group I and II respectively. Out of the 44 patients in group I, only 12 patients relapsed during the follow up period, 9 of them died, while 40 patients relapsed from group II of which 26 died thus showing a significant difference between both groups [P<0.01]. The maintenance with low dose thalidomide following initial chemotherapy may show beneficial results in terms of prevention of relapse and overall survival in comparison to the non-maintenance arm

Human heart-type fatty acid-binding protein as an early diagnostic marker of doxorubicin cardiac toxicity

Progressive cardiotoxicity following treatment with doxorubicin-based chemotherapy in patients with non-Hodgkin lymphoma [NHL] may lead to late onset cardiomyopathy. So, early prediction of toxicity can lead to prevention of heart failure in these patients. The aim of this work was to investigate the role of H-FABP as an early diagnostic marker of anthracycline-induced cardiac toxicity together with brain natriuretic peptide [BNP] as an indication of ventricular dysfunction in such patients. Our study was conducted on 40 NHL patients who received 6 cycles of a doxorubicin-containing chemotherapy protocol [CHOP], not exceeding the total allowed dose of doxorubicin [500mg/m2].Ten healthy controls were included in our study. Human heart-type fatty acid binding protein [H-FABP] was assessed 24 hours after the first cycle of CHOP. Plasma levels of BNP were estimated both before starting chemotherapy and after the last cycle of CHOP. Resting echocardiography was also performed before and at the end of chemotherapy cycles. The ejection fraction [EF] of eight of our patients decreased below 50% at the end of the sixth cycle. Elevated levels of both H-FABP and BNP were found in all patients with EF below 50% and both markers showed a positive correlation with each other. We concluded that H-FABP may serve as a reliable early marker for prediction of cardiomyopathy induced by doxorubicin. Thus, in patients with elevated H-FABP, alternative treatment modalities with no cardiac toxicity may be considered in order to prevent subsequent heart failure in these patients