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Immunomodulatory drugs (IMIDs) are important in the treatment of multiple myeloma. These drugs include, thalidomide, lenalidomide and pomalidomide. Nowadays, only lenalidomide and pomalidomide are used in clinical practice.

The exact way in which these agents work is unknown. However, it is clear that IMIDs work through different mechanisms. Studies indicate that IMIDs are able to directly destroy myeloma cells and improve the function of normal immune system cells to identify and kill myeloma cells. In addition to this, IMIDs suppress the formation of new blood vessels (angiogenesis), which interferes with the survival, growth, and spread of myeloma cells. Furthermore, IMIDs decrease the production of cell signaling molecules that promote inflammation and change the bone marrow in a way that it no longer supports the growth and survival of myeloma cells.

Common side effects that can occur in patients treated with IMIDs include fatigue, constipation or diarrhea, skin rash and a reduced level of white and red blood cells. In addition to this IMIDs increase the risk for thrombosis and can cause peripheral neuropathy (a tingling sensation in fingers and toes as a result of nerve damage). Importantly, IMIDs should not be used in pregnant women, or at the time of conception as these agents can cause sever birth-defects.

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