title: Pomalidomide is active in the treatment of anemia associated with myelofibrosis.
abstract: OBJECTIVE
  Thalidomide and lenalidomide can alleviate anemia in myelofibrosis. However, their value is undermined by their respective potential to cause peripheral neuropathy and myelosuppression. We therefore evaluated the safety and therapeutic activity of another immunomodulatory drug, pomalidomide.
  
  
  METHODS
  In a phase II randomized, multicenter, double-blind, adaptive design study, four treatment arms were evaluated: pomalidomide (2 mg/d) plus placebo, pomalidomide (2 mg/d) plus prednisone, pomalidomide (0.5 mg/d) plus prednisone, and prednisone plus placebo. Pomalidomide was administered for up to 12 28-day treatment cycles. Prednisone (30 mg/d) was given in a tapering dose schedule during the first three cycles. Response was assessed by International Working Group criteria.
  
  
  RESULTS
  Eighty-four patients with myelofibrosis-associated anemia were randomly assigned to the aforementioned treatment arms: 22, 19, 22, and 21, respectively. Response in anemia was documented in 20 patients, including 15 who became transfusion independent. Response rates in the four treatment arms were 23% (95% CI, 5% to 41%), 16% (95% CI, 0% to 33%), 36% (95% CI, 16% to 56%), and 19% (95% CI, 2% to 36%). The corresponding figures for patients receiving > or = 3 cycles of treatment (n = 62) were 38%, 23%, 40%, and 25%. Response to pomalidomide with or without prednisone was durable (range, 3.2 to 16.9+ months) and significantly better in the absence of leukocytosis (37% v 8%; P = .01); JAK2V617F or cytogenetic status did not affect response. Grade > or = 3 toxicities were infrequent and included (in each treatment arm) neutropenia (9%; 16%; 5%; 5%), thrombocytopenia (14%; 16%; 9%; 5%), and thrombosis (9%; 5%; 0%; 0%).
  
  
  CONCLUSIONS
  Pomalidomide therapy at 0.5 or 2 mg/d with or without an abbreviated course of prednisone is well tolerated in patients with myelofibrosis and active in the treatment of anemia.
authors: Mayo Clinic, 200 First St SW, Rochester MN 55905, USA. tefferi.ayalew@mayo.edu
authors: Ayalew
authors: A
authors: Tefferi
authors: Srdan
authors: S
authors: Verstovsek
authors: Giovanni
authors: G
authors: Barosi
authors: Francesco
authors: F
authors: Passamonti
authors: Gail J
authors: GJ
authors: Roboz
authors: Heinz
authors: H
authors: Gisslinger
authors: Ronald L
authors: RL
authors: Paquette
authors: Francisco
authors: F
authors: Cervantes
authors: Candido E
authors: CE
authors: Rivera
authors: H Joachim
authors: HJ
authors: Deeg
authors: Juergen
authors: J
authors: Thiele
authors: Hans M
authors: HM
authors: Kvasnicka
authors: James W
authors: JW
authors: Vardiman
authors: Yanming
authors: Y
authors: Zhang
authors: B Nebiyou
authors: BN
authors: Bekele
authors: Ruben A
authors: RA
authors: Mesa
authors: Robert P
authors: RP
authors: Gale
authors: Hagop M
authors: HM
authors: Kantarjian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006397:Hematinics / Q000008:administration & dosage*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D055728:Primary Myelofibrosis / Q000150:complications*; D011446:Prospective Studies; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D005938:Glucocorticoids; D006397:Hematinics; D007155:Immunologic Factors; D013792:Thalidomide; C467566:pomalidomide; D011241:Prednisone