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Biol Blood Marrow Transplant. 2014 Aug;20(8):1183-9. doi: 10.1016/j.bbmt.2014.04.014. Epub 2014 Apr 21.

Lenalidomide maintenance for high-risk multiple myeloma after allogeneic hematopoietic cell transplantation.

Author information

1
Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. Electronic address: melissa.alsina@moffitt.org.
2
Division of Hematology, University of Washington School of Medicine/Fred Hutchinson Cancer Research Center, Seattle, Washington.
3
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York.
4
Prospective Research, Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota.
5
Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
6
Blood and Marrow Stem Cell Transplantation Division, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey.
7
Blood and Marrow Stem Cell Transplant Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
8
Multiple Myeloma and Blood and Marrow Stem Cell Transplantation Divisions, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey.
9
Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
10
Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas.
11
Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California.
12
Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
13
Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.

Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) with reduced-intensity conditioning is an appealing option for patients with high-risk multiple myeloma (MM). However, progression after alloHCT remains a challenge. Maintenance therapy after alloHCT may offer additional disease control and allow time for a graft-versus-myeloma effect. The primary objective of this clinical trial was to determine the tolerability and safety profile of maintenance lenalidomide (LEN) given on days 1 to 21 of 28 days cycles, with intrapatient dose escalation during 12 months/cycles after alloHCT. Thirty alloHCT recipients (median age, 54 years) with high-risk MM were enrolled at 8 centers between 2009 and 2012. The median time from alloHCT to LEN initiation was 96 days (range, 66 to 171 days). Eleven patients (37%) completed maintenance and 10 mg daily was the most commonly delivered dose (44%). Most common reasons for discontinuation were acute graft-versus-host disease (GVHD) (37%) and disease progression (37%). Cumulative incidence of grades III to IV acute GVHD from time of initiation of LEN was 17%. Outcomes at 18 months after initiation of maintenance were MM progression, 28%; transplantation-related mortality, 11%; and progression-free and overall survival, 63% and 78%, respectively. The use of LEN after alloHCT is feasible at lower doses, although it is associated with a 38% incidence of acute GVHD. Survival outcomes observed in this high-risk MM population warrant further study of this approach.

KEYWORDS:

Allogeneic transplantation; Lenalidomide; Multiple myeloma

PMID:
24769014
PMCID:
PMC5036168
DOI:
10.1016/j.bbmt.2014.04.014
[Indexed for MEDLINE]
Free PMC Article

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