Lenalidomide Maintenance for High-Risk Multiple Myeloma after Allogeneic Hematopoietic Cell Transplantation

Melissa Alsina, Pamela S. Becker, Xiaobo Zhong, Alexia Adams, Parameswaran Hari, Scott Rowley, Edward A. Stadtmauer, David H. Vesole, Brent Logan, Daniel Weisdorf, Muzaffar Qazilbash, Leslie L. Popplewell, Brian McClune, William Bensinger, Marcie Riches, Sergio A. Giralt, Marcelo C. Pasquini

Research output: Contribution to journalArticle

55 Scopus citations

Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) with reduced-intensity conditioning is an appealing option for patients with high-risk multiple myeloma (MM). However, progression after alloHCT remains a challenge. Maintenance therapy after alloHCT may offer additional disease control and allow time for a graft-versus-myeloma effect. The primary objective of this clinical trial was to determine the tolerability and safety profile of maintenance lenalidomide (LEN) given on days 1 to 21 of 28 days cycles, with intrapatient dose escalation during 12 months/cycles after alloHCT. Thirty alloHCT recipients (median age, 54 years) with high-risk MM were enrolled at 8 centers between 2009 and 2012. The median time from alloHCT to LEN initiation was 96 days (range, 66 to 171 days). Eleven patients (37%) completed maintenance and 10 mg daily was the most commonly delivered dose (44%). Most common reasons for discontinuation were acute graft-versus-host disease (GVHD) (37%) and disease progression (37%). Cumulative incidence of grades III to IV acute GVHD from time of initiation of LEN was 17%. Outcomes at 18 months after initiation of maintenance were MM progression, 28%; transplantation-related mortality, 11%; and progression-free and overall survival, 63% and 78%, respectively. The use of LEN after alloHCT is feasible at lower doses, although it is associated with a 38% incidence of acute GVHD. Survival outcomes observed in this high-risk MM population warrant further study of this approach.

Original languageEnglish (US)
Pages (from-to)1183-1189
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number8
DOIs
StatePublished - Aug 2014

Keywords

  • Allogeneic transplantation
  • Lenalidomide
  • Multiple myeloma

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