Lenalidomide in the treatment of plasma cell dyscrasia: state of the art and perspectives

Palumbo, Antônio; Cavallo, Federica

doi:10.3324/haematol.2013.084871

Cited by 3 publications

(2 citation statements)

References 22 publications

(20 reference statements)

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“…After discontinuing and publishing the Boston trial, Palumbo and Cavallo advised against this combination treatment in AL patients. 24 Subsequently, Dinner et al . published the results of a third trial, and also concluded that this triple combination was toxic and rather ineffective.…”

Section: Discussionmentioning

confidence: 99%

Lenalidomide/melphalan/dexamethasone in newly diagnosed patients with immunoglobulin light chain amyloidosis: results of a prospective phase 2 study with long-term follow up

et al. 2017

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Chemotherapy in light chain amyloidosis aims to normalize the involved free light chain in serum, which leads to an improvement, or at least stabilization of organ function in most responding patients. We performed a prospective single center phase 2 trial with 50 untreated patients not eligible for high-dose treatment. The treatment schedule comprised 6 cycles of oral lenalidomide, melphalan and dexamethasone every 4 weeks. After 6 months, complete remission was achieved in 9 patients (18%), very good partial remission in 16 (32%) and partial response in 9 (18%). Overall, organ response was observed in 24 patients (48%). Hematologic and cardiac toxicities were predominant adverse events. Mortality at 3 months was low at 4% (n=2) despite the inclusion of 36% of patients (n=18) with cardiac stage Mayo 3. After a median follow-up of 50 months, median overall and event-free survival were 67.5 months and 25.1 months, respectively. We conclude that the treatment of lenalidomide, melphalan and dexamethasone is very effective in achieving a hematologic remission, organ response and, consecutively, a long survival in transplant ineligible patients with light chain amyloidosis. However, as toxicity and tolerability are the major problems of a 3-drug regimen, a strict surveillance program is necessary and sufficient to avoid severe toxicities. clinicaltrials.gov Identifier: 00883623 (Eudract2008-001405-41).

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Section: Discussionmentioning

confidence: 99%

Lenalidomide/melphalan/dexamethasone in newly diagnosed patients with immunoglobulin light chain amyloidosis: results of a prospective phase 2 study with long-term follow up

et al. 2017

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“…17 The toxicity profile of the treatment was in line with that reported in previous studies and led to dose reductions and treatment interruption in 44% and 17% of patients, respectively. 18 These results led the US In a phase I clinical dose-escalation (5 mg/day, 10 mg/day, 25 mg/day, and 50 mg/day) study of lenalidomideat Dana-Farber cancer institute, no doselimiting toxicity (DLT) was observed in patients treated at any dose level within the first 28 days; however, grade 3 myelosuppression developed after day 28 in all 13 patients treated with 50 mg/day lenalidomide. Dose reduction to 25 mg/day was well tolerated in 12 patients and therefore considered to be the maximal tolerated dose (MTD).…”

Section: Clinical Efficacymentioning

confidence: 99%

Lenalidomide: Recent Armamentarium in Management of Multiple Myeloma

Gupta¹,

Sharma²,

Khadka³

et al. 2014

J. Drug Delivery Ther.

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Lenalidomide is an analogue of thalidomide. It is an oral immunomodulatory compound with potent activity and different toxicity profile than thalidomide. Lenalidomide is one of the novel drug agents used to treat multiple myeloma. Multiple myeloma (MM) is a B cell malignancy characterized by excess monotypic plasma cells in the bone marrow. Lenalidomide in combination with dexamethasone is one of the most promising MM novel treatment options. It induces at least additive direct cytotoxicity in multiple myeloma cells.The lenalidomide has possibility of being used as an adjuvant in support of more specific immunotherapeutic interventions including cancer chemotherapy, anticancer vaccines and adoptively transferred cells which warrants further investigation.

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Emerging combination therapies for the management of multiple myeloma: the role of elotuzumab

Chen¹,

Kanate

Craig

et al. 2017

CMAR

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Treatment options for patients with multiple myeloma (MM) have increased during the past decade. Despite the significant advances, challenges remain on which combination strategies will provide the optimal response for any given patient. Defining optimal combination strategies and corresponding companion diagnostics, that will guide clinical decisions are required to target relapsed or refractory multiple myeloma (RRMM) in order to improve disease progression, survival and quality of life for patients with MM. Elotuzumab is a humanized monoclonal antibody that targets signaling lymphocytic activation molecule F7 (SLAMF7), approved by the US Food and Drug Administration (FDA) in 2015 and the European Medicines Agency in 2016 for the treatment of MM. SLAMF7 is expressed in normal and malignant plasma cells and has lower expression on natural killer (NK) cells. Experimental evidence indicates that elotuzumab exhibits anti-myeloma activity through 1) antibody-dependent cell-mediated cytotoxicity, 2) enhancing NK cells cytotoxicity and 3) interfering with adhesion of MM cells to bone marrow stem cells (BMSCs). Although elotuzumab has no single agent activity in patients with RRMM who have received one to three prior therapies, the combination of elotuzumab with anti-myeloma agents, such as immunomodulatory drugs-lenalidomide, or proteasome inhibitors (PIs)-bortezomib, remarkably improved the overall response rates and progression-free survival in MM patients with only minimal incremental toxicity. In brief, the clinical data for elotuzumab indicate that targeting SLAMF7 in combination with the use of conventional therapies is feasible and effective with a tolerable safety profile for the treatment of RRMM.

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Lenalidomide in the treatment of plasma cell dyscrasia: state of the art and perspectives

Cited by 3 publications

References 22 publications

Lenalidomide/melphalan/dexamethasone in newly diagnosed patients with immunoglobulin light chain amyloidosis: results of a prospective phase 2 study with long-term follow up

Lenalidomide/melphalan/dexamethasone in newly diagnosed patients with immunoglobulin light chain amyloidosis: results of a prospective phase 2 study with long-term follow up

Lenalidomide: Recent Armamentarium in Management of Multiple Myeloma

Emerging combination therapies for the management of multiple myeloma: the role of elotuzumab

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