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Blood, 15 August 2006, Vol. 108, No. 4, pp. 1158-1164.
Prepublished online as a Blood First Edition Paper on April 11, 2006; DOI 10.1182/blood-2006-02-004572.
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CLINICAL TRIALS AND OBSERVATIONS
Lenalidomide therapy in myelofibrosis with myeloid metaplasia
Ayalew Tefferi,
Jorge Cortes,
Srdan Verstovsek,
Ruben A. Mesa,
Deborah Thomas,
Terra L. Lasho,
William J. Hogan,
Mark R. Litzow,
Jacob B. Allred,
Dan Jones,
Catriona Byrne,
Jerome B. Zeldis,
Rhett P. Ketterling,
Rebecca F. McClure,
Francis Giles, and
Hagop M. Kantarjian
From the Mayo Clinic, Rochester, MN; The University of Texas, M. D. Anderson Cancer Center, Houston; and Celgene, Summit, NJ.
We present results of 2 similarly designed but separate phase 2 studies involving single-agent lenalidomide (CC-5013, Revlimid) in a total of 68 patients with symptomatic myelofibrosis with myeloid metaplasia (MMM). Protocol treatment consisted of oral lenalidomide at 10 mg/d (5 mg/d if baseline platelet count < 100 x 109/L) for 3 to 4 months with a plan to continue treatment for either 3 or 24 additional months, in case of response. Overall response rates were 22% for anemia, 33% for splenomegaly, and 50% for thrombocytopenia. Response in anemia was deemed impressive in 8 patients whose hemoglobin level normalized from a baseline of either transfusion dependency or hemoglobin level lower than 100 g/L. Additional treatment effects in these patients included resolution of leukoerythroblastosis (4 patients), a decrease in medullary fibrosis and angiogenesis (2 patients), and del(5)(q13q33) cytogenetic remission accompanied by a reduction in JAK2V617F mutation burden (1 patient). Grade 3 or 4 adverse events included neutropenia (31%) and thrombocytopenia (19%). We conclude that lenalidomide engenders an intriguing treatment activity in a subset of patients with MMM that includes an unprecedented effect on peripheral blood and bone marrow abnormalities.
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