Fluid Retention During Thalidomide Therapy for Refractory Multiple Myelomas

Fluid retention of more than 2 kgwith no sign of pitting edemawas observed in 5 of 15 patients with refractory multiple myelomas treated by thalidomide. Cardiac function in all except one patientwho developed overt heart failurewere controlled well by diuretics. Median time from starting thalidomide to developing fluid retention was ten days (range 6 to 41 d. The fluid retention was transient in most patients allowing thalidomide therapy to continue. However when fluid retention could not be controlled by diuretics thalidomide had to be discontinued. It is important that fluid retention is a significant adverse reaction to thalidomide therapy and that even overt heart failure can be obvious.