Use of ixazomib, lenalidomide and dexamethasone in patients with relapsed amyloid light‐chain amyloidosis. (26th January 2020)

• Record Type: Journal Article
• Authors: Cohen, Oliver C.; Sharpley, Faye; Gillmore, Julian D.; Lachmann, Helen J.; Sachchithanantham, Sajitha; Mahmood, Shameem; Fontana, Marianna; Whelan, Carol J.; Martinez‐Naharro, Ana; Kyriakou, Charalampia; Rabin, Neil; Popat, Rakesh; Yong, Kwee; Cheesman, Simon; Shah, Raakhee; Hawkins, Philip N.; Wechalekar, Ashutosh D.
• Is Part Of: British journal of haematology. Volume 189:Number 4(2020)
• Page Start: 643
• Page End: 649
• Publication Date: 2020-01-26
• Subjects: ixazomib -- lenalidomide -- amyloid light‐chain amyloidosis -- chemotherapy -- relapse; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; 616.15
• DOI: 10.1111/bjh.16401
• Languages: English
• ISSNs: 0007-1048

Abstract

Summary: With improving outcomes in amyloid light‐chain (AL) amyloidosis, there is a need to study novel agents in this setting. We report outcomes of 40 patients with relapsed AL amyloidosis treated with ixazomib + lenalidomide + dexamethasone (IRd). Haematological responses were assessed on an intention‐to‐treat basis at three months: complete response (CR) – 8 (20·5%), very good partial response (VGPR) – 8 (20·5%), partial response (PR) – 7 (17·9%) and no response (NR) – 16 (41·0%). One patient had missing data. Six patients subsequently improved response. Best responses were: CR – 10 (25·6%), VGPR – 8 (20·5%), PR – 7 (17·9%), NR – 14 (35·9%). Cardiac and renal organ responses occurred in 5·6% and 13·3% respectively. Median progession‐free survival (PFS) was 17·0 months (95% CI 7·3–20·7 months), improving to 28·8 months (95% CI 20·6–37·0 months) in those achieving CR/VGPR. Median overall survival was 29·1 months (95% CI 24–33 months). Serious adverse events were seen in 14 (35·0%) patients inclusive of 15 admissions due to: infection (6/15, 40·0%), fluid overload (5/15, 33·3%), cardiac arrhythmia (2/15, 13·3%), renal dysfunction (1/15, 6·6%) and anaemia (1/15, 6·6%). In summary, IRd is an oral treatment option with a manageable toxicity profile leading to deep responses in 47% of patients with relapsed AL amyloidosis.