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Blood, 15 November 2006, Vol. 108, No. 10, pp. 3458-3464.
Prepublished online as a Blood First Edition Paper on July 13, 2006July 18, 2006; DOI 10.1182/blood-2006-04-015909.
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Submitted April 13, 2006
Accepted May 22, 2006
A randomized phase 2 study of lenalidomide therapy for
patients with relapsed or relapsed and refractory
multiple myeloma
Paul G Richardson*, Emily Blood, Constantine S Mitsiades, Sundar Jagannath, Steven R Zeldenrust, Melissa Alsina, Robert L Schlossman, S V Rajkumar, K R Desikan, Teru Hideshima, Nikhil C Munshi, Kathleen Kelly-Colson, Deborah Doss, Mary L McKenney, Svetlana Gorelik, Diane Warren, Andrea Freeman, Rebecca Rich, A. Wu, M Olesnyckyj, K Wride, William S Dalton, Jerome Zeldis, Robert Knight, Edie Weller, and Kenneth C Anderson
Dana Farber Cancer Institute, Boston, MA
Dana-Farber Cancer Institute, Harvard Med. School
St Vincent's Comprehensive Cancer Center, NY
Mayo Clinic, Rochester, MN
H.Lee Moffitt Cancer Center, Tampa, FL
St Vincent's Comprehensive Cancer Center, NY, NY;
Dana-Farber Cancer Institute, Boston, MA
Celgene Corp. Summit, NJ
H. Lee Moffitt Cancer Center
* Corresponding author; email: paul_richardson{at}dfci.harvard.edu.
This multi-center, open-label, randomized phase 2 study
evaluated 2 dose regimens of lenalidomide for relapsed,
refractory myeloma. Seventy patients were randomized to
receive either 30 mg once-daily or 15 mg twice-daily
oral lenalidomide for 21 of every 28-day cycle. Patients
with progressive or stable disease after two cycles
received dexamethasone. Analysis of the first 70
patients showed increased grade 3-4 myelosuppression in
patients receiving 15 mg twice-daily (41% versus 13%,
p=0.03). An additional 32 patients received 30 mg once-
daily. Responses were evaluated according to EBMT
criteria. Overall response rate (complete, partial or
minor) to lenalidomide alone was 25% (24% for once-daily
and 28% for twice-daily lenalidomide, respectively).
Median overall survival in 30 mg once-daily and twice-
daily groups was 31 and 27 months. Median progression-
free survival was 7.7 months on once-daily vs 3.9 months
on twice-daily lenalidomide (p=0.2). Dexamethasone was
added in 68 patients and 29% responded. Time to first
occurrence of grade 3-4 myelosuppression was shorter in
the twice-daily group (1.8 vs 5.5 months, p=0.05).
Significant peripheral neuropathy and deep vein
thrombosis each occurred in only 3%. Lenalidomide is
active and well tolerated in relapsed, refractory
myeloma. The 30 mg once-daily regimen provides the basis
for future studies as monotherapy and with dexamethasone.

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