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Addition of lenalidomide to intensive treatment in younger and middle-aged adults with newly diagnosed AML: the HOVON-SAKK-132 trial. Blood Adv 2021; 5:1110-1121. [PMID: 33616652 DOI: 10.1182/bloodadvances.2020003855] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/14/2021] [Indexed: 11/20/2022] Open
Abstract
Lenalidomide, an antineoplastic and immunomodulatory drug, has therapeutic activity in acute myeloid leukemia (AML), but definitive studies about its therapeutic utility have been lacking. In a phase 3 study, we compared 2 induction regimens in newly diagnosed patients age 18 to 65 years with AML: idarubicine-cytarabine (cycle 1) and daunorubicin and intermediate-dose cytarabine (cycle 2) without or with lenalidomide (15 mg orally on days 1-21). One final consolidation cycle of chemotherapy or autologous stem cell transplantation (auto-SCT) or allogeneic SCT (allo-SCT) was provided according to a prognostic risk and minimal residual disease (MRD)-adapted approach. Event-free survival (EFS; primary end point) and other clinical end points were assessed. A second random assignment in patients in complete response or in complete response with incomplete hematologic recovery after cycle 3 or auto-SCT involved 6 cycles of maintenance with lenalidomide (10 mg on days 1-21) or observation. In all, 392 patients were randomly assigned to the control group, and 388 patients were randomly assigned to lenalidomide induction. At a median follow-up of 41 months, the study revealed no differences in outcome between the treatments (EFS, 44% ± 2% standard error and overall survival, 54% ± 2% at 4 years for both arms) although in an exploratory post hoc analysis, a lenalidomide benefit was suggested in SRSF2-mutant AML. In relation to the previous Dutch-Belgian Hemato-Oncology Cooperative Group and Swiss Group for Clinical Cancer Research (HOVON-SAKK) studies that used a similar 3-cycle regimen but did not pursue an MRD-guided approach, these survival estimates compare markedly more favorably. MRD status after cycle 2 lost prognostic value in intermediate-risk AML in the risk-adjusted treatment context. Maintenance with lenalidomide showed no apparent effect on relapse probability in 88 patients randomly assigned for this part of the study.
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2
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Saygin C, Larkin K, Blachly JS, Orwick S, Ngankeu A, Gregory CT, Phelps MA, Mani S, Walker A, Garzon R, Vasu S, Walsh KJ, Bhatnagar B, Klisovic RB, Grever MR, Marcucci G, Byrd JC, Blum W, Mims AS. A phase I study of lenalidomide plus chemotherapy with idarubicin and cytarabine in patients with relapsed or refractory acute myeloid leukemia and high-risk myelodysplastic syndrome. Am J Hematol 2020; 95:1457-1465. [PMID: 32777116 PMCID: PMC7821016 DOI: 10.1002/ajh.25958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022]
Abstract
Patients with relapsed/refractory (R/R) acute myeloid leukemia (AML) have poor outcomes and hematopoietic cell transplantation (HCT) is the only curative treatment. New targeted therapies improved survival in select patients with specific mutations, however management of patients without these molecular alterations is an unmet need. We conducted a phase one study of lenalidomide in combination with cytarabine/idarubicin salvage chemotherapy in patients with R/R AML and high‐risk myelodysplastic syndromes. A total of 33 patients were enrolled in the study (30 AML, 3 MDS), and treated at three dose levels with 3 + 3 design. Dose‐limiting toxicity (DLT) was seen in eight patients, including four hematologic DLTs. The most commonly observed non‐hematologic serious adverse events were febrile neutropenia, rash, sepsis and renal injury. Dose level −1, consisting of 25 mg/d lenalidomide D1‐21, 1 g/m2 cytarabine D5‐8, and 8 mg/m2 idarubicin D5‐7 was determined to be the maximum tolerated dose. Note, 15/33 (45%) of patients were able to receive pre‐planned 21 days of lenalidomide. Overall, 18 patients achieved complete remission (CR) (n = 14) or CR with incomplete count recovery (CRi) (n = 4) with total CR/CRi rate of 56%. The 1‐year and 2‐year overall survival (OS) were 24% and 10%, respectively. Among responders, 10/18 underwent allogeneic HCT and had a 1‐year OS of 40%. There was no molecular pattern associated with response. These data demonstrate that the combination had clinical activity in R/R AML. This regimen should be further investigated for patients who relapsed after HCT, and as a bridge therapy to HCT. (ClinicalTrials.gov identifier: NCT01132586).
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Affiliation(s)
- Caner Saygin
- Department of Internal Medicine The Ohio State University Columbus Ohio
| | - Karilyn Larkin
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - James S. Blachly
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Shelley Orwick
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Apollinaire Ngankeu
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Charles T. Gregory
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Mitch A. Phelps
- Division of Pharmaceutics College of Pharmacy, The Ohio State University Columbus Ohio
| | - Shylaja Mani
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Alison Walker
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Ramiro Garzon
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Sumithira Vasu
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Katherine J. Walsh
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Bhavana Bhatnagar
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Rebecca B. Klisovic
- Department of Hematology and Medical Oncology Emory University School of Medicine, Winship Cancer Institute Atlanta Georgia
| | - Michael R. Grever
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - Guido Marcucci
- Department of Hematology and Hematopoietic Cell Transplantation City of Hope Medical Center Duarte California
| | - John C. Byrd
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
| | - William Blum
- Department of Hematology and Medical Oncology Emory University School of Medicine, Winship Cancer Institute Atlanta Georgia
| | - Alice S. Mims
- Division of Hematology The Ohio State University Comprehensive Cancer Center Columbus Ohio
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3
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Piccolomo A, Schifone CP, Strafella V, Specchia G, Musto P, Albano F. Immunomodulatory Drugs in Acute Myeloid Leukemia Treatment. Cancers (Basel) 2020; 12:cancers12092528. [PMID: 32899586 PMCID: PMC7573974 DOI: 10.3390/cancers12092528] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/31/2022] Open
Abstract
Immunomodulatory drugs (IMiDs) are analogs of thalidomide. They have immunomodulatory, antiangiogenic and proapoptotic properties and exert a role in regulating the tumor microenvironment. Recently IMiDs have been investigated for their pleiotropic properties and their therapeutic applications in both solid tumors (melanoma, prostate carcinoma and differentiated thyroid cancer) and hematological malignancies. Nowadays, they are applied in de novo and relapsed/refractory multiple myeloma, in myelodysplastic syndrome, in del5q syndrome with specific use of lenalidomide and B-cell lymphoma. Several studies have been conducted in the last few years to explore IMiDs possible use in acute myeloid leukemia treatment. Here we report the mechanisms of action of IMiDs in acute myeloid leukemia and their potential future therapeutic application in this disease.
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Affiliation(s)
- Antonio Piccolomo
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem cell Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.P.); (C.P.S.); (V.S.); (P.M.)
| | - Claudia Pia Schifone
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem cell Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.P.); (C.P.S.); (V.S.); (P.M.)
| | - Vanda Strafella
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem cell Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.P.); (C.P.S.); (V.S.); (P.M.)
| | - Giorgina Specchia
- Former Full Professor of Hematology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Pellegrino Musto
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem cell Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.P.); (C.P.S.); (V.S.); (P.M.)
| | - Francesco Albano
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem cell Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.P.); (C.P.S.); (V.S.); (P.M.)
- Correspondence: ; Tel.: +39-080-5478031
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Ossenkoppele GJ, Breems DA, Stuessi G, van Norden Y, Bargetzi M, Biemond BJ, A von dem Borne P, Chalandon Y, Cloos J, Deeren D, Fehr M, Gjertsen B, Graux C, Huls G, Janssen JJJW, Jaspers A, Jongen-Lavrencic M, de Jongh E, Klein SK, van der Klift M, van Marwijk Kooy M, Maertens J, Michaux L, van der Poel MWM, van Rhenen A, Tick L, Valk P, Vekemans MC, van der Velden WJFM, de Weerdt O, Pabst T, Manz M, Löwenberg B. Lenalidomide added to standard intensive treatment for older patients with AML and high-risk MDS. Leukemia 2020; 34:1751-1759. [PMID: 32020044 DOI: 10.1038/s41375-020-0725-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/24/2019] [Accepted: 01/22/2020] [Indexed: 11/09/2022]
Abstract
More effective treatment modalities are urgently needed in patients with acute myeloid leukemia (AML) of older age. We hypothesized that adding lenalidomide to intensive standard chemotherapy might improve their outcome. After establishing a safe lenalidomide, dose elderly patients with AML were randomly assigned in this randomized Phase 2 study (n = 222) to receive standard chemotherapy ("3 + 7") with or without lenalidomide at a dose of 20 mg/day 1-21. In the second cycle, patients received cytarabine 1000 mg/m2 twice daily on days 1-6 with or without lenalidomide (20 mg/day 1-21). The CR/CRi rates in the two arms were not different (69 vs. 66%). Event-free survival (EFS) at 36 months was 19% for the standard arm versus 21% for the lenalidomide arm and overall survival (OS) 35% vs. 30%, respectively. The frequencies and grade of adverse events were not significantly different between the treatment arms. Cardiovascular toxicities were rare and equally distributed between the arms. The results of the present study show that the addition of lenalidomide to standard remission induction chemotherapy does not improve the therapeutic outcome of older AML patients. This trial is registered as number NTR2294 in The NederlandsTrial Register (www.trialregister.nl).
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Affiliation(s)
- G J Ossenkoppele
- Amsterdam University Medical Cente, location VUMC, Amsterdam, Netherlands.
| | | | - G Stuessi
- Bellinzona-IOSI, Bellinzona, Switzerland
| | - Y van Norden
- HOVON Data Center, Erasmus MC- Department of Hematology, Rotterdam, The Netherlands
| | - M Bargetzi
- Aarau- Kantonsspital, Aarau, Switzerland
| | - B J Biemond
- Amsterdam University Medical Center, location AMC, Amsterdam, Netherlands
| | | | - Y Chalandon
- University Hospital and University of Geneva, Genève, Switzerland
| | - J Cloos
- Amsterdam University Medical Cente, location VUMC, Amsterdam, Netherlands
| | - D Deeren
- Roeselare-AZ Delta, Roeselare, Belgium
| | - M Fehr
- St Gallen-Kantonnsspital, St. Gallen, Switzerland
| | - B Gjertsen
- Haukeland University Hospital, Bergen (N), Norway
| | - C Graux
- Yvoir-MontGodinne, Yvoir, Belgium
| | - G Huls
- University Medical Center, Groningen, Netherlands
| | - J J J W Janssen
- Amsterdam University Medical Cente, location VUMC, Amsterdam, Netherlands
| | - A Jaspers
- Hôpital Citadelle, Liège (B), Belgium
| | | | | | - S K Klein
- Meander Medical Center, Amersfoort, Netherlands
| | | | | | - J Maertens
- Hospital Gasthuisberg, Leuven (B), Belgium
| | - L Michaux
- Center for Human Genetics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | | | | | - L Tick
- MaximaMC Eindhoven, Eindhoven, Netherlands
| | - P Valk
- Hôpital Citadelle, Liège (B), Belgium
| | | | | | - O de Weerdt
- St Antonius Hospital, Nieuwegein, Netherlands
| | - T Pabst
- Department of Oncology, University Hospital, Inselspital and University of Bern, Bern, Switzerland
| | - M Manz
- University Hospital, Zurich, Switzerland
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5
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Leufven E, Bruserud Ø. Immunosuppression and Immunotargeted Therapy in Acute Myeloid Leukemia - The Potential Use of Checkpoint Inhibitors in Combination with Other Treatments. Curr Med Chem 2019; 26:5244-5261. [PMID: 30907305 DOI: 10.2174/0929867326666190325095853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Immunotherapy by using checkpoint inhibitors is now tried in the treatment of several malignancies, including Acute Myeloid Leukemia (AML). The treatment is tried both as monotherapy and as a part of combined therapy. METHODS Relevant publications were identified through literature searches in the PubMed database. We searched for (i) original articles describing the results from clinical studies of checkpoint inhibition; (ii) published articles describing the immunocompromised status of AML patients; and (iii) published studies of antileukemic immune reactivity and immunotherapy in AML. RESULTS Studies of monotherapy suggest that checkpoint inhibition has a modest antileukemic effect and complete hematological remissions are uncommon, whereas combination with conventional chemotherapy increases the antileukemic efficiency with acceptable toxicity. The experience with a combination of different checkpoint inhibitors is limited. Thalidomide derivatives are referred to as immunomodulatory drugs and seem to reverse leukemia-induced immunosuppression, but in addition, they have direct inhibitory effects on the AML cells. The combination of checkpoint targeting and thalidomide derivatives thus represents a strategy for dual immunotargeting together with a direct antileukemic effect. CONCLUSION Checkpoint inhibitors are now tried in AML. Experimental studies suggest that these inhibitors should be combined with immunomodulatory agents (i.e. thalidomide derivatives) and/or new targeted or conventional antileukemic treatment. Such combinations would allow dual immunotargeting (checkpoint inhibitor, immunomodulatory agents) together with a double/triple direct targeting of the leukemic cells.
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Affiliation(s)
- Eva Leufven
- Department of Clinical Science, University of Bergen, Jonas Lies vei 87, N-5020 Bergen, Norway
| | - Øystein Bruserud
- Department of Clinical Science, University of Bergen, Jonas Lies vei 87, N-5020 Bergen, Norway.,Section for Hematology, Department of Medicine, Haukeland University Hospital, N-5021, Bergen, Norway
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6
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Xie CH, Wei M, Yang FY, Wu FZ, Chen L, Wang JK, Liu Q, Huang JX. Efficacy and safety of lenalidomide for the treatment of acute myeloid leukemia: a systematic review and meta-analysis. Cancer Manag Res 2018; 10:3637-3648. [PMID: 30271212 PMCID: PMC6152603 DOI: 10.2147/cmar.s168610] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Lenalidomide is effective for the treatment of low-risk myelodysplastic syndromes with deletion 5q abnormalities. However, whether lenalidomide leads to a significant improvement in treatment response and overall survival (OS) in cases of acute myeloid leukemia (AML) remains controversial. A systematic review and a meta-analysis were performed to evaluate the efficacy and safety of lenalidomide in the treatment of AML. Methods Clinical studies were identified from the Cochrane Central Register of Controlled Trials, PubMed, Embase, and ClinicalTrials.gov. Efficacy outcomes included overall response rate (ORR), complete remission (CR), and OS. Safety was evaluated based on the incidence of grade 3 and 4 treatment-related adverse events (AEs). Results Eleven studies were included in our meta-analysis; collectively these studies featured 407 AML patients. Pooled estimates for overall ORR and CR were 31% (95% CI: 26%–36%) and 21% (95% CI: 16%–27%), respectively. Thrombocytopenia, anemia, neutropenia, and infection were the most common grade 3 and 4 AEs. Conclusion Lenalidomide may have some clinical activity in AML, but the population that would benefit from lenalidomide and incorporating lenalidomide into combination drug strategies need to be better defined.
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Affiliation(s)
- Chun-Hong Xie
- Department of Hematology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou 545000, Guangxi, China,
| | - Min Wei
- Department of Hematology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou 545000, Guangxi, China,
| | - Fei-Yan Yang
- Department of Hematology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou 545000, Guangxi, China,
| | - Fu-Zhen Wu
- Department of Hematology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou 545000, Guangxi, China,
| | - Lei Chen
- Department of Hematology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou 545000, Guangxi, China,
| | - Jian-Kun Wang
- Department of Hematology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou 545000, Guangxi, China,
| | - Qin Liu
- Department of Hematology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou 545000, Guangxi, China,
| | - Jin-Xiong Huang
- Department of Hematology, Affiliated Liuzhou People's Hospital of Guangxi University of Science and Technology (Liuzhou People's Hospital), Liuzhou 545000, Guangxi, China,
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7
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Hütter-Krönke ML, Fiedler W, Kündgen A, Krauter J, von Lilienfeld-Toal M, Döhner H, Schlenk RF. Continuous high dosing of lenalidomide in relapsed, refractory or older newly diagnosed acute myeloid leukemia patients not suitable for other treatment options - results from a phase I study. Haematologica 2018; 104:e63-e64. [PMID: 30171028 DOI: 10.3324/haematol.2018.199794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Walter Fiedler
- Department of Internal Medicine II, University Hospital Hamburg-Eppendorf, Hamburg
| | - Andrea Kündgen
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University Düsseldorf
| | - Jürgen Krauter
- Department of Internal Medicine III, Hospital Braunschweig.,Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Germany
| | | | | | - Richard F Schlenk
- Department of Internal Medicine III, University of Ulm.,National Center for Tumor Diseases, Heidelberg
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8
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DeAngelo DJ, Brunner AM, Werner L, Avigan D, Fathi AT, Sperling AS, Washington A, Stroopinsky D, Rosenblatt J, McMasters M, Luptakova K, Wadleigh M, Steensma DP, Hobbs GS, Attar EC, Amrein PC, Ebert BL, Stone RM, Ballen KK. A phase I study of lenalidomide plus chemotherapy with mitoxantrone, etoposide, and cytarabine for the reinduction of patients with acute myeloid leukemia. Am J Hematol 2018; 93:254-261. [PMID: 29119643 DOI: 10.1002/ajh.24968] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 10/27/2017] [Accepted: 11/06/2017] [Indexed: 12/17/2022]
Abstract
Patients with relapsed AML have a poor prognosis and limited responses to standard chemotherapy. Lenalidomide is an immunomodulatory drug that may modulate anti-tumor immunity. We performed a study to evaluate the safety and tolerability of lenalidomide with mitoxantrone, etoposide and cytarabine (MEC) in relapsed/refractory AML. Adult patients with relapsed/refractory AML were eligible for this phase I dose-escalation study. We enrolled 35 patients using a "3 + 3" design, with a 10 patient expansion cohort at the maximum tolerated dose (MTD). Lenalidomide was initially given days 1-14 and MEC days 4-8; due to delayed count recovery, the protocol was amended to administer lenalidomide days 1-10. The dose of lenalidomide was then escalated starting at 5 mg/d (5-10-25-50). The primary objective was tolerability and MTD determination, with secondary outcomes including overall survival (OS). The MTD of lenalidomide combined with MEC was 50 mg/d days 1-10. Among the 35 enrolled patients, 12 achieved complete remission (CR) (34%, 90%CI 21-50%); 30-day mortality was 6% and 60-day mortality 13%. The median OS for all patients was 11.5 months. Among 17 patients treated at the MTD, 7 attained CR (41%); the median OS was not reached while 12-month OS was 61%. Following therapy with MEC and lenalidomide, patient CD4+ and CD8+ T-cells demonstrated increased inflammatory responses to autologous tumor lysate. The combination of MEC and lenalidomide is tolerable with an RP2D of lenalidomide 50 mg/d days 1-10, yielding encouraging response rates. Further studies are planned to explore the potential immunomodulatory effect of lenalidomide and MEC.
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Affiliation(s)
| | | | | | - David Avigan
- Beth-Israel Deaconess Medical Center; Boston Massachusetts
| | - Amir T. Fathi
- Massachusetts General Hospital; Boston Massachusetts
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9
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Khan N, Hantel A, Knoebel RW, Artz A, Larson RA, Godley LA, Thirman MJ, Liu H, Churpek JE, King D, Odenike O, Stock W. Efficacy of single-agent decitabine in relapsed and refractory acute myeloid leukemia. Leuk Lymphoma 2017; 58:1-7. [PMID: 28278716 DOI: 10.1080/10428194.2017.1289524] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Improving therapy for relapsed/refractory AML remains a challenge. We performed a retrospective analysis of outcomes following decitabine treatment in 34 patients with relapsed/refractory AML (median age, 62; median Charlson comorbidity score, 6). Decitabine, 20 mg/m2 daily, was given in 5- (25%) or 10-day (75%) cycles. Overall response rate (OR) was 30% with 21% complete remission and 9% partial remission rate. Patients with therapy-related myeloid neoplasm (t-MN) and secondary AML had a significantly higher OR compared to those with de novo AML (70 vs. 30%; p = .02). Median overall survival of all patients was 8.5 months. Median survival in patients with t-MN or secondary AML was 12.4 months compared to 8 months in those with de novo AML (p = .20). Fifteen (44%) patients proceeded to hematopoietic stem cell transplant. These data support using 10-day treatment cycles of decitabine in patients with relapsed/refractory AML, particularly for those with secondary or therapy-related AML.
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Affiliation(s)
- Niloufer Khan
- a Departments of Medicine and Pediatrics , The University of Chicago Medicine , Chicago , IL , USA
| | - Andrew Hantel
- b Department of Medicine , Section of Hematology/Oncology, The University of Chicago Medicine , Chicago , IL , USA
| | - Randall W Knoebel
- c Department of Pharmacy , The University of Chicago Medicine , Chicago , IL , USA
| | - Andrew Artz
- b Department of Medicine , Section of Hematology/Oncology, The University of Chicago Medicine , Chicago , IL , USA
| | - Richard A Larson
- b Department of Medicine , Section of Hematology/Oncology, The University of Chicago Medicine , Chicago , IL , USA
| | - Lucy A Godley
- b Department of Medicine , Section of Hematology/Oncology, The University of Chicago Medicine , Chicago , IL , USA
| | - Michael J Thirman
- b Department of Medicine , Section of Hematology/Oncology, The University of Chicago Medicine , Chicago , IL , USA
| | - Hongtao Liu
- b Department of Medicine , Section of Hematology/Oncology, The University of Chicago Medicine , Chicago , IL , USA
| | - Jane E Churpek
- b Department of Medicine , Section of Hematology/Oncology, The University of Chicago Medicine , Chicago , IL , USA
| | - Darren King
- d Department of Medicine , Section of Hematology/Oncology, The University of Michigan , Ann Arbor , MI , USA
| | - Olatoyosi Odenike
- b Department of Medicine , Section of Hematology/Oncology, The University of Chicago Medicine , Chicago , IL , USA
| | - Wendy Stock
- b Department of Medicine , Section of Hematology/Oncology, The University of Chicago Medicine , Chicago , IL , USA
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