title: Salvage therapy with lenalidomide and dexamethasone in patients with advanced AL amyloidosis refractory to melphalan, bortezomib, and thalidomide.
abstract: The increasing number of effective agents allows rescue therapy of patients with light-chain (AL) amyloidosis refractory to ≥2 previous treatments. Lenalidomide is effective in this disease and its toxicity profile encourages its use in salvage regimens. All the patients with AL amyloidosis refractory to both melphalan and bortezomib referred to our center between July 2007 and July 2009 were treated with the combination of lenalidomide and dexamethasone. Twenty-four consecutive patients were enrolled. Seventy-nine percent were also refractory to thalidomide. Two patients died before evaluation of response, and 50% experienced severe adverse events. Survival was significantly shorter in subjects with troponin I >0.1 ng/mL and in patients diagnosed <18 months before treatment initiation. Hematologic response was observed in 41% of patients and prolonged survival (median 10 months vs. not reached, P = 0.005) independently from troponin I concentration and from pre-treatment disease duration. Salvage therapy beyond second line of treatment can improve survival in AL amyloidosis and lenalidomide plus dexamethasone is a valuable option in this setting.
authors.affiliation: Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere scientifico Policlinico San Matteo, Pavia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Palladini
authors.forename: Paola
authors.initials: P
authors.lastname: Russo
authors.forename: Andrea
authors.initials: A
authors.lastname: Foli
authors.forename: Paolo
authors.initials: P
authors.lastname: Milani
authors.forename: Francesca
authors.initials: F
authors.lastname: Lavatelli
authors.forename: Laura
authors.initials: L
authors.lastname: Obici
authors.forename: Mario
authors.initials: M
authors.lastname: Nuvolone
authors.forename: Silvia
authors.initials: S
authors.lastname: Brugnatelli
authors.forename: Rosangela
authors.initials: R
authors.lastname: Invernizzi
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Merlini
mesh_terms: D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000188:drug therapy* / Q000503:physiopathology; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D003907:Dexamethasone / Q000627:therapeutic use*; D019008:Drug Resistance, Neoplasm; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000077269:Lenalidomide; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D008875:Middle Aged; D011719:Pyrazines / Q000627:therapeutic use*; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D007166:Immunosuppressive Agents; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D000077269:Lenalidomide; D008558:Melphalan