Clinical Efficacy Of Low-dose Thalidomide With Prednisone In The Treatment Of 23 Patients With Chronic Idiopathic Myelofibrosis

【Objective】To investigate the efficacy and safety of low-dose thalidomide with prednisone in the treatment of patients with chronic idiopathic myelof-ibrosis(cIMF).【Method】Twenty-three patients treated with thalidomide 50～100mg/d and predn-isone 30mg/d regimen which maintained for at least 3 months then taper-ed. The hematological parameters, sizes of spleen and liver, transfusion dependence and bone marrow biopsy were examined and all the adverse ef-fects were recorded to assess the treatment efficacy and tolerance.【Result】Eighteen of the twenty-three patients finished the 3-month treatment, and 2 patients (11.1%) got improvement,4patients (22.2%) got progress. Five of sixteen patients with anemia reached the normal hemoglobin(Hb) level (for male≥120g/L, for female≥110g/L), the Hb increase was 45g/L, 29g/L,78g/L,63g/L and 65g/L respectively. Two patients exceeded 100g/L, and the Hb increase was both 45g/L. Two patients became erythrocyte tra-nsfusion independent,and the Hb increase was 5g/L and 19g/L respective-ly. It was effective in 56.3%of the patients with anemia. Four thromboc-ytopenia patients with platelet count 40×109/L,84×109/L,9×109/L and 72×109/L respectively were corrected, and all the 4 patients with plate-let count<20×109/L who depended on transfusion achieved no response.In 1/6 leucocytopenia patients, leucocyte increased from 3.39×109/L to 5.0×109/L. In 4/8 patients, peripheral blood immature granulocyte disappear-ed, and 2 patients degraded from 24%and 12%to 2%and 5%respectively. In 5/8 patients, peripheral blood immature erythrocyte disappeared, and 3 patients degraded from 16%,7%and 4%to 8%,2%and 2%respectively. In 11 /12 patients with splenomegaly, spleen size decreased 1.3～13cm (11%～100%, median 46%).One of four patients with hepatomegaly got normal, the others minified from 3.7cm,2. lcm and 5. Ocm to 1.7cm,2cm and 2cm respec-tively, and the median minification was 55%(5%～100%). Thirteen of eight-een patients carried out biopsy after treatment, and 4 patiens obviously improved in fibroplasia. Mild adverse effects were observed, and the man-ifestation was dizziness, fatigue, etc. Most of patients were well tolera-ted, and the major adverse effects needed no management.【Conclusion】Low-dose Thalidomide with prednisone is a safe and effective method to treat cIMF. It is valuable to further study with large sample.