Lenalidomide and dexamethasone (LEN plus DEX) treatment in relapsed/refractory multiple myeloma (RRMM) patients (pts) and risk of second primary malignancies (SPM): Analysis of MM-009/010.

Dimopoulos, M. A.; Orłowski, Robert Z.; Niesvizky, Rubén; Lonial, Sagar; Brandenburg, Nancy A.; Weber, Donna M.

doi:10.1200/jco.2011.29.15_suppl.8009

Cited by 12 publications

(16 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Using NCI SEER data, no increase in incidence of solid tumors was noted compared with the general population. 34 In parallel with the aforementioned studies reporting on lenalidomide maintenance and excess MDS/AML development in multiple myeloma, other investigations have been evaluating the role of lenalidomide treatment in the setting of MDS. For example, a recent study reported that lenalidomide used as treatment for 5qϪ MDS was not associated with AML progression.…”

Section: Treatment-related Factorsmentioning

confidence: 99%

“…35 Among patients with relapsed/refractory multiple myeloma, 2 retrospective studies have evaluated the role of lenalidomide in relation to the risk of second malignancies. 33,34 Based on 230 relapsed/refractory multiple myeloma patients treated with lenalidomide-based regimens, Reece and Goswami found MDS/AML in 2.6% (6 patients) at a median of 76 months from the time of diagnosis of multiple myeloma and 61 months from the time of initiation of lenalidomide. 33 Although the prior exposure to alkylating agents was similar in both groups, patients who developed AML/MDS were older (median, 68 years; range, 54-76 years; vs median, 61 years; range, 32-80 years), less likely to have had high-dose melphalan/ASCT (2, 33%; vs 149, 82%) and had longer …”

Section: Treatment-related Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Second malignancies after multiple myeloma: from 1960s to 2010s

Thomas

Mailankody

Korde

et al. 2012

Blood

114

109

View full text Add to dashboard Cite

Based on small numbers, recent reports from 3 randomized trials have consistently demonstrated more hematologic malignancies in patients treated with lenalidomide as maintenance (vs placebo). This fact has prompted concern and highlighted the association between multiple myeloma and second malignancies. Furthermore, an excess of acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) after multiple myeloma has been known for over 4 decades. Most prior studies have been restricted because of small numbers of patients, inadequate follow-up, and limitations of ascertainment of second malignancies. Although the underlying biologic mechanisms of AML/MDS after multiple myeloma are unknown, treatment-related factors are presumed to be responsible. Recently, an excess risk of AML/MDS was found among 5652 patients with IgG/IgA (but not IgM) monoclonal gammopathy of undetermined significance, supporting a role for disease-related factors. Furthermore, there is evidence to suggest that polymorphisms in germline genes may contribute to a person's susceptibility to subsequent cancers, whereas the potential influence of environmental and behavioral factors remains poorly understood. This review discusses current knowledge regarding second malignancies after multiple myeloma and gives future directions for efforts designed to characterize underlying biologic mechanisms, with the goal to maximize survival and minimize the risk for second malignancies for individual patients. (Blood. 2012;119(12): 2731-2737) IntroductionAfter decades of virtually no progress, multiple myeloma survival has improved significantly in the last 10 years, in younger patients even 2-to 3-fold. 1-3 Indeed, multiple myeloma has seen more remarkable progress in treatment and patient outcomes than any other cancer in the last decade. With improvements in survival, a relatively new clinical challenge that has emerged is the risk of second malignancies. This pattern of increase in second malignancies has been observed in other cancers with available curative therapies and favorable outcomes. Survivors of testicular cancer are at up to 3-fold higher risk of developing a second malignancy than the general population. 4 Survivors of Hodgkin lymphoma have more than 3 times greater risk of solid tumors. Fifteen years after diagnosis, the cumulative mortality from second malignancies exceeds cumulative mortality from Hodgkin lymphoma. 5,6 In the United States alone, the number of cancer survivors has tripled since 1971 and is growing by 2% each year; cancer survivors constitute 3.5% of the United States population. 7 Indeed, secondor higher-order cancers account for 18% of incident cancers in the United States, making them the third most common cancer diagnosis. 7 Based on the National Cancer Institute Surveillance, Epidemiology and End Results (NCI SEER) database, compared with the general population, cancer survivors have a 14% increased risk of developing a malignancy. 7 In the late 1960s, based on a restricted number of patients, an association betwee...

show abstract

Section: Treatment-related Factorsmentioning

confidence: 99%

Section: Treatment-related Factorsmentioning

confidence: 99%

Second malignancies after multiple myeloma: from 1960s to 2010s

Thomas

Mailankody

Korde

et al. 2012

Blood

114

109

View full text Add to dashboard Cite

show abstract

“…In the pivotal studies [5,8] with lenalidomidedexamethasone for relapsed myeloma however, the incidence of invasive SPMs was within the expected background rate for this population and similar across treatment arms [26] In summary, taking into account the limitations of a single case, this report illustrates the potential of lenalidomide for long-term continuous treatment in MM, with side eff ects controllable through tailored patient management including step-wise dose adaptations.…”

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 65%

Continuous treatment with lenalidomide in multiple myeloma: a case report

Müldür

Weissmann

Leitgeb

et al. 2012

memo

View full text Add to dashboard Cite

“…A retrospective review of SMs in 2 phase 3 trials (MM-009 and MM-010) revealed 8 (2.3%) SMs on the lenalidomide/dexamethasone arm of which 2 (0.6%) were MDS and 6 (1.7%) solid tumors compared with 2 (0.6%) on the placebo/ dexamethasone arm, of which none were hematologic and 2 (0.6%) were solid tumors. 10,11 Updates of the lenalidomide maintenance trial (MM-015) in Ͼ 65-year-old newly diagnosed ASCT-ineligible patients by Palumbo et al (MP 9 cycles vs MPR 9 cycles vs MPR 9 cycles followed by lenalidomide maintenance until progression) revealed incidence rates of SMs of 4 of 150 in MPR-R (IR ϭ 1.40), 6 of 152 in MPR (IR ϭ 2.05), and 2 of 153 in the MP (IR ϭ 0.67) arms, including 2 MDS in MPR-R and 2 AML cases in each of MPR-R and MPR (AML incidence was 0.7% vs 0% in the MP arm). 12 Finally, Durie presented a retrospective review of pooled data from lenalidomide-based treatment arms of 11 Celgenesponsored studies in relapsed refractory MM patients who received Ն 24 months of lenalidomide.…”

Section: Introductionmentioning

confidence: 99%

What is the Benefit of Maintenance Therapy with Lenalidomide or Bortezomib after Autologous Stem Cell Transplantation in Multiple Myeloma and What is the Risk of Developing a Secondary Primary Malignancy?

Scott

Reece

2011

Hematology

View full text Add to dashboard Cite

An otherwise healthy 60-year-old male was diagnosed with stage II multiple myeloma by the International Staging System characterized by anemia, diffuse lytic bone lesions, IgG kappa paraproteinemia, 45% bone marrow plasmacytosis and the t(4;14) by FISH and conventional cytogenetics. The patient had a very good partial remission with initial induction therapy consisting of four 3-week cycles of bortezomib 1.3 mg/m 2 IV on days 1, 4, 8, and 11 plus dexamethasone 40 mg days 1-4 (all cycles), followed by a cyclophosphamide and G-CSF mobilized melphalan 200 mg/m 2 autologous stem cell transplantation (ASCT) and experienced minimal side effects. He is doing well 60 days post-ASCT and is in a near complete remission. His oncologist recommends maintenance therapy with lenalidomide or bortezomib, but the patient is concerned about the increased risk of developing a secondary malignancy (SM), and because he has had such an encouraging response to induction therapy, he wonders if he could remain off therapy.

show abstract

Lenalidomide and dexamethasone (LEN plus DEX) treatment in relapsed/refractory multiple myeloma (RRMM) patients (pts) and risk of second primary malignancies (SPM): Analysis of MM-009/010.

Cited by 12 publications

References 0 publications

Second malignancies after multiple myeloma: from 1960s to 2010s

Second malignancies after multiple myeloma: from 1960s to 2010s

Continuous treatment with lenalidomide in multiple myeloma: a case report

What is the Benefit of Maintenance Therapy with Lenalidomide or Bortezomib after Autologous Stem Cell Transplantation in Multiple Myeloma and What is the Risk of Developing a Secondary Primary Malignancy?

Contact Info

Product

Resources

About