title: Toxicity-reduced, myeloablative allograft followed by lenalidomide maintenance as salvage therapy for refractory/relapsed myeloma patients.
abstract: Relapse after dose-reduced allograft in advanced myeloma patients remains high. To reduce the risk of relapse, we investigated a myeloablative toxicity-reduced allograft (aSCT) consisting of i.v. BU and CY followed by lenalidomide maintenance therapy in 33 patients with multiple myeloma (MM) who relapsed following an autograft after a median of 12 months. The cumulative incidence of non-relapse mortality at 1 year was 6% (95% confidence interval (CI): 0-14). After a median interval of 168 days following aSCT, 24 patients started with a median dose of 5 mg (r, 5-15) lenalidomide without dexamethasone. During follow-up, 13 patients discontinued lenalidomide owing to progressive disease (n=6), GvHD (n=3), thrombocytopenia (n=2), or fatigue (n=2). Major toxicities of lenalidomide were GvHD II-III (28%), viral reactivation (16%), thrombocytopenia (III-IV°,16%), neutropenia (III/IV°, 8%), peripheral neuropathy (I/II°, 16%), or other infectious complication (8%). Cumulative incidence of relapse at 3 years was 42% (95% CI: 18-66). The 3-year estimated probability of PFS and OS was 52% (95% CI: 28-76) and 79% (95% CI: 63-95), respectively. Toxicity-reduced myeloablative allograft followed by lenalidomide maintenance is feasible and effective in relapsed patients with MM, but the induction of GvHD should be considered.
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. nkroeger@uke.uni-hamburg.de
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.forename: T
authors.initials: T
authors.lastname: Zabelina
authors.forename: E
authors.initials: E
authors.lastname: Klyuchnikov
authors.forename: M
authors.initials: M
authors.lastname: Kropff
authors.forename: K-H
authors.initials: KH
authors.lastname: Pflüger
authors.forename: A
authors.initials: A
authors.lastname: Burchert
authors.forename: T
authors.initials: T
authors.lastname: Stübig
authors.forename: C
authors.initials: C
authors.lastname: Wolschke
authors.forename: F
authors.initials: F
authors.lastname: Ayuk
authors.forename: Y
authors.initials: Y
authors.lastname: Hildebrandt
authors.forename: U
authors.initials: U
authors.lastname: Bacher
authors.forename: A
authors.initials: A
authors.lastname: Badbaran
authors.forename: G
authors.initials: G
authors.lastname: Schilling
authors.forename: T
authors.initials: T
authors.lastname: Hansen
authors.forename: D
authors.initials: D
authors.lastname: Atanackovic
authors.forename: A R
authors.initials: AR
authors.lastname: Zander
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012008:Recurrence; D016879:Salvage Therapy; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D013792:Thalidomide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D013792:Thalidomide; D000077269:Lenalidomide