Abstract
Increased neoangiogenesis has been reported in myelofibrosis with myeloid metaplasia (MMM). Thus we studied the effects of thalidomide, an antiangiogenic drug, in 12 MMM patients. Before treatment, all the cases showed a significantly increased micro-vessel density (MVD); in all eight tested cases bFGF and VEGF plasma levels were higher than controls. All patients presented disease progression in the last 3 months with standard therapy, regarding splenomegaly, anemia and/or thrombocytopenia and/or hyperleukocytosis. Thalidomide was administered at daily doses increasing from 100 to 600 mg. Eleven out of 12 patients were evaluable. No progression of disease was seen during the treatment in any case. In particular, spleen size decreased in 7/11 patients, anemia improved in 3/4 (two are now transfusion independent), thrombocytopenia in 2/2 and hyperleukocytosis in 2/5 patients. Side-effects were frequent, although not severe. After treatment, VEGF and bFGF plasma levels varied widely and in selected cases decreased. In particular, VEGF and/or bFGF decreased in 4/5 responders and in 1/3 non-responders. Moreover, MVD significantly decreased in all the responders evaluated after treatment. We conclude that thalidomide is a feasible therapy in MMM patients and looks promising at least to control the growth progression of disease.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Tefferi A . Myelofibrosis with myeloid metaplasia N Engl J Med 2000 342: 1255–1265
Folkman J . Tumor angiogenesis Adv Cancer Res 1974 19: 331–358
Folkman J, Klagsbrun M . Angiogenic factors Science 1987 235: 442–447
Folkman J . What is the evidence that tumors are angiogenesis dependent J Natl Cancer Inst 1990 19: 331–358
Vacca A, Ribatti D, Roncali L, Dammacco F . Angiogenesis in B cell lymphoproliferative diseases. Biological and clinical studies Leuk Lymphoma 1995 20: 27–41
Ribatti D, Vacca A, Nico B, Fanelli M, Roncali L, Dammacco F . Angiogenesis spectrum in the stroma of B-cell non Hodgkin's lymphomas. An immunohistochemical and ultrastructural study Eur J Haematol 1996 56: 45–53
Fiedler W, Graeven U, Ergun S, Verago S, Kilic N, Stockschader M, Hossfeld DK . Vascular endothelial growth factor, a possible paracrine growth factor in human acute myeloid leukemia Blood 1997 89: 1870–1875
Foss HD, Araujo D, Demel G, Klotzbach H, Hummel M, Stein H . Expression of vascular endothelial growth factor in lymphomas and Castleman's disease J Pathol 1997 83: 44–50
Perez-Atayde AR, Sallan SE, Tedrow U, Connors S, Allred E, Folkman J . Spectrum of tumor angiogenesis in the bone marrow of children with acute lymphoblastic leukemia Am J Pathol 1997 150: 815–821
Peterson L, Kini A, Kay N . Angiogenesis is increased in B-cell chronic lymphocytic leukemia Blood 1997 97: 2529–2530
Salven P, Teerenhovi L, Joensuu H . A high pretreatment serum vascular endothelial growth factor concentration is associated with poor outcome in non-Hodgkin's lymphomas Blood 1997 90: 3167–3172
Hussong JW, Rodgers GM, Shami PJ . Evidence of increased angiogenesis in patients with acute myeloid leukemia Blood 2000 95: 309–313
Aguayo A, Estey E, Kantarjan H, Manshouri T, Gidel C, Keating M, Giles F, Estrov Z, Barlogie B, Albitar M . Cellular vascular endothelial growth factor is a predictor of outcome in patients with acute myeloid leukemia Blood 1999 94: 3717–3721
Aguayo A, O'Brien S, Keating M, Manshouri, Gidel C, Barlogie B, Beran M, Koller C, Kantarjan H, Albitar M . Clinical relevance of intracellular vascular endothelial growth factor levels in B-cell chronic lymphocytic leukemia Blood 2000 96: 768–770
Aguayo A, Kantarjan H, Manshouri T, Gidel C, Estey E, Thomas D, Koller C, Estrov Z, O'Brien S, Keating M, Freireich E, Albitar M . Angiogenesis in acute and chronic leukemias and myelodysplastic syndromes Blood 2000 96: 2240–2245
Hussong JW, Rodgers GM, Shami PJ . Evidence of increased angiogenesis in patients with acute myeloid leukemia Blood 2000 95: 309–313
Padrò T, Ruiz S, Biecker R, Burger H, Steins M, Kienast J, Buchner T, Berdel WE, Mesters RM . Increased angiogenesis in the bone marrow of patients with acute myeloid leukemia Blood 2000 95: 2637–2644
Pruneri G, Bertolini F, Soligo D, Carboni N, Cortelezzi A, Ferrucci PF, Buffa R, Lambertenghi-Delilieris G, Pezzella F . Angiogenesis in myelodysplastic syndromes Br J Cancer 1999 81: 1398–1401
Reddy V, Moreb J . Prognostic correlation of increased angiogenesis in acute myeloid leukemia with cytogenetics Blood 2000 96: 1617–1618
Salven P, Orpana A, Teerenhovi, Joensuu H . Simultaneous elevation in the serum concentrations of the angiogenic growth factors VEGF and bFGF is an independent predictor of poor prognosis in non-Hodgkin lymphoma: a single-institution study of 200 patients Blood 2000 96: 3712–3718
D'Amato RJ, Loughnan MS, Flynn E, Folkman J . Thalidomide is an inhibitor of angiogenesis Proc Natl Acad Sci USA 1994 91: 4082–4085
Singhal S, Metha J, Desikan R, Ayers D, Roberson P, Eddlemon P, Munshi N, Anaissie E, Wilson C, Dhodapkar M, Zeldis J, Barlogie B . Antitumor activity of thalidomide in refractory multiple myeloma N Engl J Med 1999 341: 1565–1571
Mesa R, Hanson CA, Rajkumar SV, Schroeder G, Tefferi A . Evaluation and clinical correlation of bone marrow angiogenesis in myelofibrosis with myeloid metaplasia Blood 2000 96: 3374–3380
Barosi G, Grossi A, Comotti B, Musto P, Gamba G, Marchetti M . Safety and efficacy of thalidomide in patients with myelofibrosis with myeloid metaplasia Br J Haematol 2001 114: 78–83
Piccaluga PP, Finelli C, Ricci P, Cavo M, Pileri SA, Isidori A, Malagola M, Grafone T, Tura S, Visani G . Antiangiogenic therapy with thalidomide improves anemia, thrombocytopenia, hyperleucocytosis, splenomegaly in idiopathic myelofibrosis Blood 2000 96: 688 (Abstr.)
Raza A, Mejer P, Dutt D, Zorat F, Lisak L, Nascimben F, du Randt M, Kaspar C, Goldberg C, Loew J, Dar S, Gezer S, Venugopal P, Zeldis J . Thalidomide produces transfusion independence in long-standing refractory anemias of patients with myelodysplastic syndrome Blood 2001 98: 958–965
Barosi G, Ambrosetti A, Finelli C, Grossi A, Leoni P, Liberato NL, Petti MC, Pogliani E, Ricetti M, Rupoli S, Visani G, Tura S . The Italian Consensus Conference on diagnostic criteria for myelofibrosis with myeloid metaplasia Br J Haematol 1999 104: 730–737
Dupriez B, Morel P, Demory JL, Lai JL, Simon M, Plantier I, Bauters F . Prognostic factors in agnogenic myeloid metaplasia: a report on 195 cases with a new scoring system Blood 1996 88: 1013–1018
Buyssens N, Bourgeois NH . Chronic myelocytic leukemia versus idiopathic myelofibrosis: a diagnostic problem in bone marrow biopsies Cancer 1977 40: 1548–1561
Heimburg S, Oehler SK, Papadopoulus T, Caffier H, Kristen P, Dieti J . Prognostic relevance of the endothelial marker CD34 in ovarian cancer Anticancer Res 1999 19: 2527–2529
Weidner N, Semple JP, Welch WR, Folkman J . Tumor angiogenesis and metastasis-correlation in invasive breast carcinoma N Engl J Med 1991 324: 1–8
Tefferi A, Elliot MA . Serious myeloproliferative reactions associated with the use of thalidomide in myelofibrosis with myeloid metaplasia Blood 2000 96: 4007
Lisak LA, Little L, Dean L, Ekbal M, du Randt M, Hussain M, Kaistha V, Raza A . Delayed responses to thalidomide in patients with myelodysplastic syndromes Blood 2000 96: 4861 (Abstr.)
Palumbo A, Giaccone L, Bertola A, Pregno P, Bringhen S, Rus C, Triolo S, Gallo E, Pileri A, Boccadoro M . Low-dose thalidomide plus dexamethasone is an effective salvage therapy for advanced myeloma Haematologica 2001 86: 399–433
Geitz H, Handt S, Zwingenberger K . Thalidomide selectively modulates the density of cell surface molecules involved in the adhesion cascade Immunopharmacology 1996 31: 213–221
Sampaio EP, Sarno EN, Galilly R, Cohn ZA, Kaplan G . Thalidomide selectively inhibits tumor necrosis factor alpha production by stimulated human monocytes J Exp Med 1991 173: 699–703
Corral LG, Muller GW, Moreira AL, Chen I, Wu M, Stirling D, Kaplan G . Selection of novel analogs of thalidomide with enhanced tumor necrosis factor alpha inhibitory activity Mol Med 1996 2: 506–515
Haslett PAJ, Corral LG, Albert M, Kaplan G . Thalidomide costimulates primary human T lymphocytes, preferentially inducing proliferation, cytokine production, and cytotoxic responses in the CD8+ subset J Exp Med 1998 187: 1885–1892
McHugh SM, Rifkin IR, Deighton J, Wilson AB, Lachmann PS, Lockwood CM, Ewan PW . The immunosoppressive drug thalidomide induces T helper cell type 2 (Th 2) and concomitantly inhibits Th 1 cytokine production in mitogen and antigen-stimulated human peripheral blood mononuclear cell cultures Clin Exp Immunol 1995 99: 160–167
Acknowledgements
This work was supported in part by MURST ex 60% (S Tura) and FONDI ex 40% (S Tura). The authors wish to thank Ms Milena Piccioli and Ms Federica Sandri for their contribution. This paper is dedicated to the memory of Alessandro Piccaluga.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Piccaluga, P., Visani, G., Pileri, S. et al. Clinical efficacy and antiangiogenic activity of thalidomide in myelofibrosis with myeloid metaplasia. A pilot study. Leukemia 16, 1609–1614 (2002). https://doi.org/10.1038/sj.leu.2402596
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.leu.2402596
Keywords
This article is cited by
-
Platelet-derived growth factor alpha mediates the proliferation of peripheral T-cell lymphoma cells via an autocrine regulatory pathway
Leukemia (2014)
-
Prospective study of combination therapy with low-dose thalidomide plus prednisolone ameliorating cytopenia in primary myelofibrosis
International Journal of Hematology (2011)
-
Evaluation of Modified PEG-Anilinoquinazoline Derivatives as Potential Agents for EGFR Imaging in Cancer by Small Animal PET
Molecular Imaging and Biology (2010)
-
Therapeutic renaissance of thalidomide in the treatment of haematological malignancies
Leukemia (2005)
-
Chronic idiopathic myelofibrosis: independent prognostic importance of bone marrow microvascular density evaluated by CD105 (endoglin) immunostaining
Modern Pathology (2004)