title: Lenalidomide plus donor-lymphocytes infusion after allogeneic stem-cell transplantation with reduced-intensity conditioning in patients with high-risk multiple myeloma.
abstract: Myeloma relapse is the main cause of death after allogeneic stem cell transplantation. The aim of our observational study was to evaluate the anti-myeloma effect of lenalidomide followed by donor-lymphocyte infusion (DLI) as post-transplantation adoptive immunotherapy. Twelve patients with refractory myeloma were analyzed. The median age at transplantation was 56 years (range, 46-64 years). All patients received reduced-intensity conditioning. Patients were included if progressive or residual disease was observed at day +100 and if no signs of graft-vs-host disease were evident. DLIs were administered after two cycles of lenalidomide. Median dose of lenalidomide was 15 mg (range, 10-25 mg). Patients received a median of six cycles (range, 1-10 cycles). Nine patients (60%) received an escalating dose of DLI. The 1 and 2-year probability of progression-free survival was 75% and 50%, and overall survival was 83% and 69%, respectively. Median overall survival was not reached and median progression-free survival was 23 months. Lenalidomide is well tolerated after allogeneic stem cell transplantation; the combination with DLI did not cause a higher risk of graft-vs-host disease; an immunological synergistic effect was probably present with this strategy. This combination should be evaluated further in a larger cohort of patients.
authors.affiliation: Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France. elcheikhj@marseille.fnclcc.fr
authors.forename: Jean
authors.initials: J
authors.lastname: El-Cheikh
authors.forename: Roberto
authors.initials: R
authors.lastname: Crocchiolo
authors.forename: Sabine
authors.initials: S
authors.lastname: Furst
authors.forename: Patrick
authors.initials: P
authors.lastname: Ladaique
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna
authors.forename: Catherine
authors.initials: C
authors.lastname: Faucher
authors.forename: Angela
authors.initials: A
authors.lastname: Granata
authors.forename: Claire
authors.initials: C
authors.lastname: Oudin
authors.forename: Claude
authors.initials: C
authors.lastname: Lemarie
authors.forename: Boris
authors.initials: B
authors.lastname: Calmels
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Stoppa
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Schiano De Colella
authors.forename: Segolene
authors.initials: S
authors.lastname: Duran
authors.forename: Christian
authors.initials: C
authors.lastname: Chabannon
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D016219:Immunotherapy, Adoptive / Q000379:methods*; D000077269:Lenalidomide; D019520:Living Donors; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy; D033581:Stem Cell Transplantation; D015996:Survival Rate; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous
chemical_list: D000970:Antineoplastic Agents; D013792:Thalidomide; D000077269:Lenalidomide