Feasibility of Lenalidomide Therapy for Persistent Chronic Lymphocytic Leukemia after Allogeneic Transplantation

Abstract

In patients with chronic lymphocytic leukemia (CLL), persistence of disease after allogeneic stem cell transplantation (alloSCT) can result in poor outcomes. In an effort to improve these outcomes, patients with persistent CLL who were 90 to 100 days beyond alloSCT with no evidence of graft-versus-host-disease (GVHD) were randomized to receive lenalidomide or standard care (withdrawal of immunosuppression followed by donor lymphocyte infusion). Lenalidomide was initiated at 5 mg every other day and increased to 10 mg daily, if tolerated, in each patient. Of 38 patients enrolled, 17 (45%) met the eligibility criteria for randomization. Of these 17 patients, 8 were randomized to undergo lenalidomide therapy. Five (62%) patients had to stop taking the drug because of toxicity. The main reason for drug discontinuation was acute GVHD in 43% of patients. This incidence was 11% in the patients who were randomized to not receive lenalidomide. With a median follow-up of 2.6 years, the median survival was 3.4 years for those receiving lenalidomide. This was not reached in patients randomized to not receive lenalidomide and in patients in complete remission who were not randomized. These results suggested that treatments other than lenalidomide are needed for persistent CLL after alloSCT.

Treatment with mogamulizumab or lenalidomide for relapsed adult T‐cell leukemia/lymphoma after allogeneic hematopoietic stem cell transplantation: The Nagasaki transplant group experience

“…Patients were treated with an oral dose of 10 or 15‐mg Len daily and given continuously until documented progressive disease (PD) or intolerability. The doses of Len were based on the previous studies, some of which showed a development of severe GVHD during Len among posttransplant patients . Therefore, patients were treated with reduced dose, such as 10 to 15 mg/day, of Len, referring the starting dose of maintenance therapy for relapsed multiple myeloma after allo‐HSCT …”

“…The doses of Len were based on the previous studies, some of which showed a development of severe GVHD during Len among posttransplant patients. [31][32][33][34][35] Therefore, patients were treated with reduced dose, such as 10 to 15 mg/day, of Len, referring the starting dose of maintenance therapy for relapsed multiple myeloma after allo-HSCT. 31,33,34 Regarding patients whose creatinine clearance of 30 to 50 mL/ min, the starting dose of Len was reduced to 40% from 10 mg daily (ie, 5 mg every other day as a minimum dose).…”

“…31,33,34 Regarding patients whose creatinine clearance of 30 to 50 mL/ min, the starting dose of Len was reduced to 40% from 10 mg daily (ie, 5 mg every other day as a minimum dose). 33,35,37,38 Prophylactic anticoagulation therapy during Len was administered with aspirin.…”

“…These agents are considered to be new therapeutic candidates for relapsed ATL after allo‐HSCT; however, the outcomes of Mog or Len for relapsed ATL after allo‐HSCT remain unclear. Previous studies reported that (a) the pretransplant administration of Mog for ATL patients correlated with the development of severe graft‐versus‐host disease (GVHD), and (b) the posttransplant use of Len for multiple myeloma, myelodysplastic syndrome, acute myeloid leukemia, and chronic lymphocytic leukemia increased the risk of GVHD . Thus, based on the effects of Mog and Len on the immune system, the posttransplant use of Mog or Len could potentially increase the risk of GVHD in ATL patients.…”

“…Previous studies reported that (a) the pretransplant administration of Mog for ATL patients correlated with the development of severe graft-versus-host disease (GVHD), 30 and (b) the posttransplant use of Len for multiple myeloma, myelodysplastic syndrome, acute myeloid leukemia, and chronic lymphocytic leukemia increased the risk of GVHD. [31][32][33][34][35] Thus, based on the effects of Mog and Len on the immune system, the posttransplant use of Mog or Len could potentially increase the risk of GVHD in ATL patients. Moreover, we previously reported distinct patterns of infectious complications in posttransplant patients with ATL.…”