Vol 2, No 2 (2011)
Review paper
Published online: 2011-07-15
Mechanisms of action of immunomodulatory drugs in plasma cell myeloma
Hematologia 2011;2(2):105-115.
Abstract
Plasma cell myeloma is a multi-stage disease that is characterized by monoclonal proliferation
of plasma cells. The last decades brought a major breakthrough in the treatment of multiple
myeloma, concerning the new medicine and the therapeutic schema which vitally lengthen the
lifespan of patients suffering from this incurable disease. Thalidomide has been the first
within the group of the immunomodulatory drugs which proved its efficacy in the treatment of
patients with myeloma. Identification of its immunomodulatory, anti-inflammatory and antiangiogenic
activity resulted in the development of analogues of enhanced activity and lesser
toxicity which caused the rapid introduction of lenalidomide into clinical practice.
Lenalidomide has turned out to be an immunomodulatory agent able to regulate both the
cellular and humoral immune responses by altering cytokine production, it regulates T cell costimulation and augments the NK cell cytotoxicity. It also shows to have anti-angiogenic
properties. The latest studies have demonstrated that another immunomodulatory drug —
pomalidomide — has a potent anti-myeloma activity in vitro and in vivo, acting both directly
on myeloma cells and on the cells in the bone marrow microenvironment. The aforementioned
data of the literature suggest high efficacy of thalidomide, lenalidomide and pomalidomide in
the treatment of myeloma.
Hematologia 2011; 2, 2: 105–115
Hematologia 2011; 2, 2: 105–115
Keywords: plasma cell myelomathalidomidelenalidomidepomalidomide