Another chance for thalidomide

The potential use of thalidomide in the therapy of graft-versus-host disease--a review of clinical and laboratory information

This article reviews the historical development of thalidomide as an immunosuppressive agent and the current state of knowledge of thalidomide as an anti-graft-versus-host disease (GVHD) agent. The evidence suggests that metabolites of thalidomide act at an early stage in the antigen recognition-activation pathway of graft T lymphocytes and down regulate normal lymphocyte responses. This effect seems to have beneficial effects in both acute and chronic GVHD, but the optimal mode of use in the clinical setting remains to be determined.

Thalidomide for autoimmune disease

The therapeutic efficacy of thalidomide in erythema nodosum leprosum suggests that thalidomide might play a useful therapeutic role in other human immune-complex diseases. Thalidomide has shown anti-inflammatory or immunosuppressive actions in several animal models. Current evidence suggests that its rapid activity in ENL may result from suppression of neutrophil chemotaxis and phagocytosis. Scattered anecdotal clinical reports of apparent response to thalidomide in various autoimmune diseases are hardly conclusive, but underline the desirability of appropriate pilot trials of thalidomide in autoimmune diseases, particularly those in which immune complex deposition plays a prominent role. Provided that a contraindication in fertile women is strictly observed, thalidomide therapy appears to be quite safe.