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Blood, 15 January 2007, Vol. 109, No. 2, pp. 465-470.
Prepublished online as a Blood First Edition Paper on September 28, 2006; DOI 10.1182/blood-2006-07-032987.
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CLINICAL TRIALS AND OBSERVATIONS
The activity of lenalidomide with or without dexamethasone in patients with primary systemic amyloidosis
Angela Dispenzieri1,3,,
Martha Q. Lacy1,
Steven R. Zeldenrust1,
Suzanne R. Hayman1,
Shaji K. Kumar1,
Susan M. Geyer2,
John A. Lust1,3,
Jacob B. Allred2,
Thomas E. Witzig1,3,
S. Vincent Rajkumar1,
Philip R. Greipp1,3,
Stephen J. Russell1,4,
Brian Kabat2, and
Morie A. Gertz1
1 Division of Hematology,
2 Department of Biostatistics,
3 Department of Laboratory Medicine, and
4 Department of Molecular Medicine, Mayo Clinic, Rochester, MN
Primary systemic amyloidosis (AL) is an incurable plasma cell disorder. Lenalidomide, especially in conjunction with dexamethasone, is highly active in patients with multiple myeloma. We studied the toxicity and efficacy of lenalidomide in patients with AL. Patients with symptomatic AL, a measurable plasma cell disorder, and adequate hematologic and renal reserve were eligible. Patients received single-agent lenalidomide. If there was no evidence of progression after 3 months or of hematologic response after 3 cycles, dexamethasone was added. Twenty-three patients were enrolled. Thirteen were previously treated. Organ involvement was cardiac (64%), renal (73%), hepatic (23%), and nerve (14%). Within the first 3 cycles of therapy, 10 patients discontinued treatment: 4 early deaths, 3 adverse events, and 3 other causes. With a median follow-up of 17 months, 10 patients responded to treatment. In these patients, responses included 9 hematologic, 4 renal, 2 cardiac, and 2 hepatic. All but one of the responders had dexamethasone added to their treatment program. The most common grade 3 or 4 adverse events at least possibly attributable to lenalidomide were neutropenia (45%), thrombocytopenia (27%), rash (18%), and fatigue (18%). In AL patients, we saw limited activity of single-agent lenalidomide, but significant activity of the combination with dexamethasone, which warrants further investigation.
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