Pomalidomide is active in the treatment of anemia associated with myelofibrosis.
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.
Tefferi
Ayalew
A
Mayo Clinic, 200 First St SW, Rochester MN 55905, USA. tefferi.ayalew@mayo.edu
Verstovsek
Srdan
S
Barosi
Giovanni
G
Passamonti
Francesco
F
Roboz
Gail J
GJ
Gisslinger
Heinz
H
Paquette
Ronald L
RL
Cervantes
Francisco
F
Rivera
Candido E
CE
Deeg
H Joachim
HJ
Thiele
Juergen
J
Kvasnicka
Hans M
HM
Vardiman
James W
JW
Zhang
Yanming
Y
Bekele
B Nebiyou
BN
Mesa
Ruben A
RA
Gale
Robert P
RP
Kantarjian
Hagop M
HM
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*
D005938:Glucocorticoids; D006397:Hematinics; D007155:Immunologic Factors; D013792:Thalidomide; C467566:pomalidomide; D011241:Prednisone