Toxicity-reduced, myeloablative allograft followed by lenalidomide maintenance as salvage therapy for refractory/relapsed myeloma patients
| Autor: | Anita Badbaran, Djordje Atanackovic, Timon Hansen, Kropff M, Francis Ayuk, Tatjana Zabelina, Thomas Stübig, Evgeny Klyuchnikov, Axel R. Zander, Pflüger Kh, N Kröger, York Hildebrandt, Ulrike Bacher, Christine Wolschke, Georgia Schilling, Andreas Burchert |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Transplantation Conditioning Adolescent Salvage therapy Angiogenesis Inhibitors Disease-Free Survival Young Adult Refractory Recurrence hemic and lymphatic diseases medicine Humans Transplantation Homologous Lenalidomide Multiple myeloma Aged Salvage Therapy Transplantation business.industry Hematology Allo sct Middle Aged medicine.disease Surgery Thalidomide Clinical trial surgical procedures operative Toxicity Female business Multiple Myeloma medicine.drug Stem Cell Transplantation |
| Zdroj: | Bone marrow transplantation. 48(3) |
| ISSN: | 1476-5365 |
| Popis: | Relapse after dose-reduced allograft in advanced myeloma patients remains high. To reduce the risk of relapse, we investigated a myeloablative toxicity-reduced allograft (aSCT) consisting of i.v. BU and CY followed by lenalidomide maintenance therapy in 33 patients with multiple myeloma (MM) who relapsed following an autograft after a median of 12 months. The cumulative incidence of non-relapse mortality at 1 year was 6% (95% confidence interval (CI): 0-14). After a median interval of 168 days following aSCT, 24 patients started with a median dose of 5 mg (r, 5-15) lenalidomide without dexamethasone. During follow-up, 13 patients discontinued lenalidomide owing to progressive disease (n=6), GvHD (n=3), thrombocytopenia (n=2), or fatigue (n=2). Major toxicities of lenalidomide were GvHD II-III (28%), viral reactivation (16%), thrombocytopenia (III-IV°,16%), neutropenia (III/IV°, 8%), peripheral neuropathy (I/II°, 16%), or other infectious complication (8%). Cumulative incidence of relapse at 3 years was 42% (95% CI: 18-66). The 3-year estimated probability of PFS and OS was 52% (95% CI: 28-76) and 79% (95% CI: 63-95), respectively. Toxicity-reduced myeloablative allograft followed by lenalidomide maintenance is feasible and effective in relapsed patients with MM, but the induction of GvHD should be considered. |
| Databáze: | OpenAIRE |
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