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Toxicity-reduced, myeloablative allograft followed by lenalidomide maintenance as salvage therapy for refractory/relapsed myeloma patients
- Source :
- Bone marrow transplantation. 48(3)
- Publication Year :
- 2012
-
Abstract
- Relapse after dose-reduced allograft in advanced myeloma patients remains high. To reduce the risk of relapse, we investigated a myeloablative toxicity-reduced allograft (aSCT) consisting of i.v. BU and CY followed by lenalidomide maintenance therapy in 33 patients with multiple myeloma (MM) who relapsed following an autograft after a median of 12 months. The cumulative incidence of non-relapse mortality at 1 year was 6% (95% confidence interval (CI): 0-14). After a median interval of 168 days following aSCT, 24 patients started with a median dose of 5 mg (r, 5-15) lenalidomide without dexamethasone. During follow-up, 13 patients discontinued lenalidomide owing to progressive disease (n=6), GvHD (n=3), thrombocytopenia (n=2), or fatigue (n=2). Major toxicities of lenalidomide were GvHD II-III (28%), viral reactivation (16%), thrombocytopenia (III-IV°,16%), neutropenia (III/IV°, 8%), peripheral neuropathy (I/II°, 16%), or other infectious complication (8%). Cumulative incidence of relapse at 3 years was 42% (95% CI: 18-66). The 3-year estimated probability of PFS and OS was 52% (95% CI: 28-76) and 79% (95% CI: 63-95), respectively. Toxicity-reduced myeloablative allograft followed by lenalidomide maintenance is feasible and effective in relapsed patients with MM, but the induction of GvHD should be considered.
- Subjects :
- Adult
Male
medicine.medical_specialty
Transplantation Conditioning
Adolescent
Salvage therapy
Angiogenesis Inhibitors
Disease-Free Survival
Young Adult
Refractory
Recurrence
hemic and lymphatic diseases
medicine
Humans
Transplantation, Homologous
Lenalidomide
Multiple myeloma
Aged
Salvage Therapy
Transplantation
business.industry
Hematology
Allo sct
Middle Aged
medicine.disease
Surgery
Thalidomide
Clinical trial
surgical procedures, operative
Toxicity
Female
business
Multiple Myeloma
medicine.drug
Stem Cell Transplantation
Subjects
Details
- ISSN :
- 14765365
- Volume :
- 48
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Bone marrow transplantation
- Accession number :
- edsair.doi.dedup.....d7a1b6ef1f6fee6eabebfa15c9880883