In the recent years, several pieces of evidence have pointed out that disease progression in multiple myeloma (MM) is characterized by an increased bone marrow neovascularization. Targeting the mechanisms that control angiogenesis could thus represent an innovative therapeutic approach to MM. Thalidomide, a glutamic acid derivative with sedative properties, is able to inhibit angiogenesis in murine models; this compound has recently demonstrated to be effective in relapsed/refractory MM, leading to a 30–40% response, coupled with mild systemic toxicity. Inhibition of angiogenesis is probably just one of the mechanisms by which thalidomide exerts its action in MM, as immunomodulation and inhibition of cytokine production by bone marrow stroma could also be involved. At present, several studies are ongoing, aiming at testing thalidomide-based drug combinations, mainly with dexamethasone, but also with conventional chemotherapy; the results that have been obtained so far show a synergistic effect of the drug combinations, with a response rate ranging from 50 to 70% in pretreated patients. There is now growing interest in novel compounds with potential antiangiogenic effects, among them a promising activity both in vitro and in animal models has been displayed by thalidomide analogs, inhibitors of vascular endothelial growth factor receptor-2 and endostatin.

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