We would like to thank Dr. Musto for his thoughtful comments concerning our recently published article1 on the use of thalidomide in myelodysplastic syndrome (MDS). Although the protocol was originally written in early 1998 with a maximum target dose of 200 mg per day of thalidomide, the protocol was not activated until the year 2001 because of initial skepticism of the potential benefits of thalidomide in this hematologic disorder. For similar reasons, only patients with very advanced disease and any performance status were eligible to participate in this trial. As previously noted, the therapeutic results of this trial were unsatisfactory and were published as such without an attempt to make the article under discussion a comprehensive review of the use of thalidomide in MDS. We do acknowledge in this letter the important contributions of Drs. Strup, Musto, Bouscary, Bowen, and colleagues2–5 to this subject, and we agree with these investigators that the population most likely to benefit with this agent may be those patients with earlier stage disease, younger age, and anemia as the only significant blood cytopenia. We concluded that the use of thalidomide in unselected patients with MDS at the dose and schedule used in this trial was not warranted. However, we believe that even at a lower dose, the tolerability of this agent by patients with MDS is limited. On the basis of preliminary results of the multicenter trial of lenalidomide in patients with non-5q minus low-risk and intermediate-1 risk MDS presented by Drs. Raza and List6 that showed significant activity and minimal toxicity, we believe this analog of thalidomide would be a better option for these patients.
Alvaro Moreno-Aspitia MD*, Gerardo Colon-Otero MD*, * Division of Hematology and Oncology Mayo Clinic, Jacksonville, Florida.