Thalidomide in Treating Patients With Myelodysplastic Syndrome

OBJECTIVES:

I. Determine whether thalidomide improves cytopenias in patients with myelodysplastic syndromes.

II. Determine the toxicity of this regimen in these patients. III. Determine whether this regimen down regulates the peripheral blood levels of tumor necrosis factor alpha, interferon gamma, and interleukin-12 and whether these changes correlate with clinical response in these patients.

IV. Determine whether this regimen alters the peripheral blood T-cell subset distribution and whether these changes correlate with clinical response in these patients.

V. Determine the effect of this regimen on bone marrow microvessel density and whether these effects correlate with clinical response in these patients.

OUTLINE: This is a multicenter study. Patients are stratified according to prognosis (favorable vs unfavorable). (Favorable stratum closed to accrual 12/28/01)

Patients receive oral thalidomide once daily. Treatment continues for 5 years in the absence of disease progression or unacceptable toxicity.

Patients are followed every 6 months for 1 year and then annually for 4 years.

PROJECTED ACCRUAL: A total of 20-58 patients (10-29 per stratum) will be accrued for this study within 20 months. (Favorable stratum closed to accrual 12/28/01)

Inclusion criteria

• Pre-transfusion hemoglobin =< 10 g/dL
• Pre-transfusion platelet count =< 50,000/μL
• Absolute neutrophil count < 1000/μL
• Total bilirubin ≤ 1.5 x UNL
• Alkaline phosphatase ≤ 3 x UNL
• AST ≤ 3 x UNL
• Creatinine ≤ 1.5 x UNL
• A diagnosis of MDS as demonstrated in the bone marrow; any subtypes are eligible including:

• Refractory anemia (cytopenia)
• Refractory anemia with ringed sideroblasts
• Chronic myelomonocytic leukemia
• Refractory anemia with excess blasts
• Refractory anemia with excess blasts in transformation
• Unclassified MDS
• Patients with refractory anemia with excess blasts in transformation who are not candidates for (or who decline) induction chemotherapy are eligible; those patients who were candidates for (and accepted) induction chemotherapy should have failed at least 1 chemotherapy regimen prior to entry
• Patients who are candidates for marrow transplantation should have this option discussed prior to study entry

Exclusion criteria

• Any of the following as this regimen may be harmful to a developing fetus or nursing child:

• Pregnant women
• Nursing women
• Women of childbearing potential or their sexual partners who are unwilling to employ 2 adequate methods of contraception (condoms, diaphragm, birth control pills, injections, intrauterine device [IUD], surgical sterilization, subcutaneous implants, or abstinence, etc.)
• Peripheral neuropathy (by history or clinical exam)
• Concomitant therapy ≤ 30 days for myelodysplastic syndrome with any specific agent including chemotherapy, corticosteroids and/or growth factors (i.e. erythropoietin, G-CSF, GM-CSF, thrombopoietic agent); patients on chronic low-dose corticosteriods (< 20 mg/d) for reasons other than MDS are allowed
• Uncontrolled infections