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Thalidomide-Induced Neuropathy

      To the Editor: In discussing the use of thalidomide for treating multiple myeloma, Rajkumar et al
      • Rajkumar SV
      • Gertz MA
      • Kyle RA
      • Greipp PR
      • Mayo Clinic Myeloma, Amyloid, and Dysproteinemia Group
      Current therapy for multiple myeloma.
      mentioned that the drug can cause peripheral neuropathy. According to the System for Thalidomide Education and Prescribing Safety program,
      THALIDOMID (thalidomide). Balancing the benefits and risks. Peripheral Neuropathy.
      “If symptoms [of nerve damage] develop, THALIDOMID should be stopped immediately to limit further damage.” It is unclear in their article whether Rajkumar et al follow this recommendation. Also, it would be important to learn how many patients have developed neuropathy and whether sural nerve action potentials are tested to monitor these patients, as discussed in an earlier publication by these authors.
      • Rajkumar SV
      • Witzig TE
      A review of angiogenesis and anti-angiogenic therapy with thalidomide in multiple myeloma.
      Sural nerve action potentials can also be used to detect subclinical neuropathy.
      • Powell RJ
      • Gardner-Medwin JM
      Guideline for the clinical use and dispensing of thalidomide.

      REFERENCES

        • Rajkumar SV
        • Gertz MA
        • Kyle RA
        • Greipp PR
        • Mayo Clinic Myeloma, Amyloid, and Dysproteinemia Group
        Current therapy for multiple myeloma.
        Mayo Clin Proc. 2002; 77: 813-822
      1. THALIDOMID (thalidomide). Balancing the benefits and risks. Peripheral Neuropathy.
        Celgene. 1999; (CGD57 Monograph 11. QXD 18-20.)
        • Rajkumar SV
        • Witzig TE
        A review of angiogenesis and anti-angiogenic therapy with thalidomide in multiple myeloma.
        Cancer Treat Rev. 2000; 26: 351-362
        • Powell RJ
        • Gardner-Medwin JM
        Guideline for the clinical use and dispensing of thalidomide.
        Postgrad Med J. 1994; 70: 901-904

      Linked Article

      • Thalidomide-Induced Neuropathy: In Response
        Mayo Clinic ProceedingsVol. 77Issue 12
        • In Brief
          As stated in our article, it is important to note that the US Food and Drug Administration has approved the use of thalidomide only for the treatment of erythema nodosum leprosum. The manufacturer's prescriber information recommends that therapy be discontinued if symptoms of neuropathy develop, and in the United States, any use of thalidomide other than for erythema nodosum leprosum is not recommended and constitutes “off-label use.”
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