Yazarlar : Kumar SK, Hayman SR, Buadi FK, et al.

Yayın : Blood

Yayın Yılı : 2012

Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/22504925

Konu : Myelom

Literatür İçeriği :  

Abstract

Light chain (AL) amyloidosis remains incurable despite recent therapeutic advances. Given the activity of lenalidomide-alkylating agent combination in myeloma, we designed this phase 2 trial of lenalidomide, cyclophosphamide and dexamethasone in AL amyloidosis. Thirty-five patients, including 24 previously untreated, were enrolled. Nearly half of the patients had cardiac stage III disease and 28% had ≥3 organs involved. The overall hematological response (≥PR) rate was 60%, including 40% with very good partial response or better. Using serum free light chain for assessing response, 77% patients had a hematological response. Organ responses were seen in 29% of patients and were limited to those with a hematological response. The median hematologic progression free survival was 28.3 months and the median overall survival was 37.8 months. Hematological toxicity was the predominant adverse event, followed by fatigue, edema and gastrointestinal symptoms. A grade 3 or higher toxicity occurred in 26 patients (74%) including ≥grade 3 hematologic toxicity in 16 patients (46%) and ≥grade 3 non-hematologic toxicity in 25 patients (71%). Seven patients (20%) died on study, primarily due to advanced disease. CRd is an effective combination for treatment of AL amyloidosis and leads to durable hematologic responses as well as organ responses with manageable toxicity. The trial was registered at www.clinicaltrials.gov (NCT00564889).

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