In a sense, the good news about thalidomide as a treatment for myeloma began two years ago with Jimmy Clark, 60, a retired grocery store owner who lives in Oxford, Ala.
Nine years ago, Clark was diagnosed with myeloma, a cancer that arises in the bone marrow. He had a stem cell transplant, in which primitive immune system cells from his circulation were removed and preserved while he underwent aggressive chemotherapy. The stem cells were re-infused so that they could grow up into a new immune system.
It didn't work. So he underwent a second transplant, this time with bone marrow donated by someone else. That didn't work either.
In late 1997, his physician, Dr. Seema Singhal, formerly of the University of Arkansas and now of the South Carolina Cancer Center in Columbia, S.C., suggested thalidomide.
Within a week of the thalidomide start, she says, tests showed that Clark's cancer was receding. Within three months, Clark, who followed Singhal to her clinic, had what Singhal describes in this week's New England Journal of Medicine as a ''nearly complete remission.''
His progress prompted her to begin a study of the drug in 84 patients in early 1998.
It has been nearly two years since Clark began taking thalidomide. In that time, his cancer began to progress after Singhal reduced his dose from 800 milligrams a day to 400. Like others who take the drug, Clark had some side effects, chiefly fatigue and drowsiness.
Singhal has raised his dose to 1,200 mg a day and has added a steroid to suppress his cancer cells.
Clark says he's feeling fine. His tests, he says, show his cancer cells ''are very low ... I feel good about it.''
JUDY FOREMAN
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