Lenalidomide is safe and active in Waldenström macroglobulinemia.

Abstract

Lenalidomide is manageable and effective in multiple myeloma, particularly in elderly patients. Surprisingly, the combination of lenalidomide with rituximab produced clinically significant anemia at 25 mg/day for 21/28 days, the highest possible dose, in Waldenström's Macroglobulinemia (WM). We aimed to determine the maximum tolerated dose (MTD) of single agent lenalidomide and determine its impact on WM. RV-WM-0426 is a multicenter dose escalation open label phase 1/2 study of lenalidomide in relapsed/refractory WM (RRWM). Lenalidomide was given orally 21/28 days per cycle for 1 year, at escalated dose of 15 to 20 mg during phase 1 to determine the MTD; the phase 2 part was conducted at the MTD. Seventeen RRWM patients were included. The MTD was established at 15 mg/day 21/28. By ITT analysis, the overall response rate was 29%. With a median follow-up of 36 months, median TTP was 16 months (95% CI 5.5-26), the 5-year OS was 91%. The most frequent adverse events ≥ grade 3 at 15 mg were 14% anemia and 43% neutropenia. The MTD of lenalidomide is 15 mg/day 21/28 days in RRWM. Lenalidomide is active in the treatment of RRWM and the safety profile appears manageable. Future studies may look into combinations of lenalidomide and continuous dosing.

• Authors: Guillemette Fouquet, Stéphanie Guidez, Marie-Odile Petillon, Chanaz Louni, Bella Ohyba, Malek Dib, Stéphanie Poulain, Charles Herbaux, Audrey Martin, Béatrice Thielemans, Pauline Brice, Sylvain Choquet, Jana Bakala, Claire Bories, Hélène Demarquette, Morgane Nudel, Olivier Tournilhac, Bertrand Arnulf, Steven LeGouill, Pierre Morel, Anne Banos, Lionel Karlin, Gilles Salles, Véronique Leblond, Xavier Leleu
• Journal: American journal of hematology (Am J Hematol) Vol. 90 Issue 11 Pg. 1055-9 (Nov 2015) ISSN: 1096-8652 [Electronic] United States
• PMID: 26284823 (Publication Type: Clinical Trial, Phase I, Clinical Trial, Phase II, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 Wiley Periodicals, Inc.

Chemical References

• Antineoplastic Agents
• Immunologic Factors
• Thalidomide
• Lenalidomide

Topics

• Administration, Oral
• Aged
• Aged, 80 and over
• Anemia (chemically induced, pathology)
• Antineoplastic Agents (administration & dosage, adverse effects)
• Drug Administration Schedule
• Drug Dosage Calculations
• Female
• Humans
• Immunologic Factors (administration & dosage, adverse effects)
• Lenalidomide
• Male
• Maximum Tolerated Dose
• Middle Aged
• Neutropenia (chemically induced, pathology)
• Recurrence
• Survival Analysis
• Thalidomide (administration & dosage, adverse effects, analogs & derivatives)
• Treatment Outcome
• Waldenstrom Macroglobulinemia (drug therapy, mortality, pathology)