Pomalidomide is active in the treatment of anemia associated with myelofibrosis.

Abstract

PURPOSE:

Thalidomide and lenalidomide can alleviate anemia in myelofibrosis. However, their value is undermined by their respective potential to cause peripheral neuropathy and myelosuppression. We therefore evaluated the safety and therapeutic activity of another immunomodulatory drug, pomalidomide.

METHODS:

In a phase II randomized, multicenter, double-blind, adaptive design study, four treatment arms were evaluated: pomalidomide (2 mg/d) plus placebo, pomalidomide (2 mg/d) plus prednisone, pomalidomide (0.5 mg/d) plus prednisone, and prednisone plus placebo. Pomalidomide was administered for up to 12 28-day treatment cycles. Prednisone (30 mg/d) was given in a tapering dose schedule during the first three cycles. Response was assessed by International Working Group criteria.

RESULTS:

Eighty-four patients with myelofibrosis-associated anemia were randomly assigned to the aforementioned treatment arms: 22, 19, 22, and 21, respectively. Response in anemia was documented in 20 patients, including 15 who became transfusion independent. Response rates in the four treatment arms were 23% (95% CI, 5% to 41%), 16% (95% CI, 0% to 33%), 36% (95% CI, 16% to 56%), and 19% (95% CI, 2% to 36%). The corresponding figures for patients receiving > or = 3 cycles of treatment (n = 62) were 38%, 23%, 40%, and 25%. Response to pomalidomide with or without prednisone was durable (range, 3.2 to 16.9+ months) and significantly better in the absence of leukocytosis (37% v 8%; P = .01); JAK2V617F or cytogenetic status did not affect response. Grade > or = 3 toxicities were infrequent and included (in each treatment arm) neutropenia (9%; 16%; 5%; 5%), thrombocytopenia (14%; 16%; 9%; 5%), and thrombosis (9%; 5%; 0%; 0%).

CONCLUSION:

Pomalidomide therapy at 0.5 or 2 mg/d with or without an abbreviated course of prednisone is well tolerated in patients with myelofibrosis and active in the treatment of anemia.

• Authors: Ayalew Tefferi, Srdan Verstovsek, Giovanni Barosi, Francesco Passamonti, Gail J Roboz, Heinz Gisslinger, Ronald L Paquette, Francisco Cervantes, Candido E Rivera, H Joachim Deeg, Juergen Thiele, Hans M Kvasnicka, James W Vardiman, Yanming Zhang, B Nebiyou Bekele, Ruben A Mesa, Robert P Gale, Hagop M Kantarjian
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 27 Issue 27 Pg. 4563-9 (Sep 20 2009) ISSN: 1527-7755 [Electronic] United States
• PMID: 19652059 (Publication Type: Clinical Trial, Phase II, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Glucocorticoids
• Hematinics
• Immunologic Factors
• Thalidomide
• pomalidomide
• Prednisone

Topics

• Adult
• Aged
• Aged, 80 and over
• Anemia (drug therapy, etiology)
• Double-Blind Method
• Female
• Glucocorticoids (administration & dosage)
• Hematinics (administration & dosage)
• Humans
• Immunologic Factors (administration & dosage)
• Male
• Middle Aged
• Prednisone (administration & dosage)
• Primary Myelofibrosis (complications)
• Prospective Studies
• Thalidomide (administration & dosage, analogs & derivatives)