Lenalidomide as salvage therapy after allo-SCT for multiple myeloma is effective and leads to an increase of activated NK (NKp44(+)) and T (HLA-DR(+)) cells.
We investigated efficacy and toxicity of lenalidomide in 24 heavily pretreated myeloma patients with a median age of 59 years (range: 37-70) and relapse after allo-SCT. Lenalidomide was given at a dose of 15 mg (n=4), or 25 mg (n=20), orally once daily on day 1 to day 1 every 28 days, with (n=20) or without (n=4) DHAP. The median number of lenalidomide cycles was five (range: 2-17). Major side effects were leukopenia (grade 4: 4%, grade 3: 21% and grade 2: 17%) and thrombocytopenia (grade 3: 17% and grade 2: 29%); infectious complications were observed in 50%. Non-hematological toxicity consisted of muscle cramps (n=9), fatigue (n=5) and constipation (n=2). Mild grade I-II GVHD was seen in three patients. Response was achieved in 66%: CR in 8%, VGPR in 8%, PR in 50% and SD in 13%. The median time to progression was 9.7 months (95% confidence interval (CI): 7.5-11.9), and median OS was 19.9 months (95% CI: 17.3-22.5). Immunomonitoring after lenalidomide showed significant increase of activated NK (NKp44(+)) and T (HLA-DR(+)) cells, as well as regulatory T cells (CD4(+), CD25(+), CD127(lo)), supporting an immunomodulating anti-myeloma effect of lenalidomide.
Lioznov
M
M
Department for Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
El-Cheikh
J
J
Hoffmann
F
F
Hildebrandt
Y
Y
Ayuk
F
F
Wolschke
C
C
Atanackovic
D
D
Schilling
G
G
Badbaran
A
A
Bacher
U
U
Fehse
B
B
Zander
A R
AR
Blaise
D
D
Mohty
M
M
Kröger
N
N
D006684:HLA-DR Antigens / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007694:Killer Cells, Natural / Q000166:cytology* / Q000276:immunology; D000077269:Lenalidomide; D007970:Leukopenia / Q000139:chemically induced; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000628:therapy; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods*; D013601:T-Lymphocytes / Q000276:immunology; D013792:Thalidomide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced; D016896:Treatment Outcome
D006684:HLA-DR Antigens; D013792:Thalidomide; D000077269:Lenalidomide