Efficacy of lenalidomide as salvage therapy for patients with AL amyloidosis. (2nd October 2018)

• Record Type: Journal Article
• Authors: Kastritis, Efstathios; Gavriatopoulou, Maria; Roussou, Maria; Bagratuni, Tina; Migkou, Magdalini; Fotiou, Despina; Ziogas, Dimitrios C.; Kanellias, Nikolaos; Eleutherakis-Papaiakovou, Evangelos; Dialoupi, Ioanna; Ntanasis-Stathopoulos, Ioannis; Spyropoulou-Vlachou, Mairylin; Psimenou, Erasmia; Gakiopoulou, Harikleia; Marinaki, Smaragdi; Papadopoulou, Elektra; Ntalianis, Argyrios; Terpos, Evangelos; Dimopoulos, Meletios A.
• Is Part Of: Amyloid. Volume 25:Number 4(2018)
• Page Start: 234
• Page End: 241
• Publication Date: 2018-10-02
• Subjects: Lenalidomide -- bortezomib -- free light chains -- dialysis -- pneumonitis -- rash; Amyloidosis -- Periodicals; 616.3995
• DOI: 10.1080/13506129.2018.1540410
• Languages: English
• ISSNs: 1350-6129

Abstract

Abstract: We retrospectively evaluated 55 consecutive patients who received at least one dose of lenalidomide for relapsed/refractory AL amyloidosis. Their median age was 63 years; 72% had heart and 75% kidney involvement and 13% were on dialysis; while 20%, 46% and 34% had Mayo stage -1, -2 and -3 disease, respectively. Median time from start of primary therapy to lenalidomide was 15 months (range 2–100) and median number of prior therapies was 1 (range 1–4); 73% of the patients had prior bortezomib and 42% were bortezomib-refractory. On intent to treat, haematologic response rate was 51% (5.5% CRs, 20% VGPRs) and was 56% versus 40% for patients with and without prior bortezomib and 47% versus 62.5% for bortezomib refractory versus non-refractory patients ( p = .351). Organ response was achieved by 16% of evaluable patients (22% renal, 7% liver and 3% cardiac); however, 10 (21%) patients progressed to dialysis. Median survival post lenalidomide was 25 months. Bortezomib-refractory patients had worse outcome (median survival of 10.5 versus 25 months for bortezomib-sensitive patients versus not reached for bortezomib-naive patients, p = .011). Median lenalidomide dose was 10 mg and no patient received the 25 mg dose; however, in 60% a dose reduction was required. Median duration of lenalidomide therapy was 7.2 months and 46% discontinued lenalidomide before completion of planned therapy, mainly due to toxicity (26%) or disease progression/no response (13%). We conclude that although lenalidomide is a major salvage option for patients with relapsed/refractory AL amyloidosis, its toxicity in patients with AL amyloidosis is significant and doses should be adjusted for optimal tolerability.