Abstract
Allo-SCT can result in long-term remission in patients with multiple myeloma (MM), although its overall role in disease management remains controversial. We evaluated lenalidomide monotherapy response and tolerability among 18 patients with MM who progressed or relapsed after Allo-SCT, who were enrolled a median of 12 months (range 3–104) following transplant. Treatment duration of lenalidomide was 8 months (range 1–57). Ten patients required dose reductions from 25 to 5–20 mg at a median of three cycles (range 1–12): eight for neutropenia, one for thrombocytopenia and one for myalgias and weakness. Serious adverse events (N=5) included H1N1 influenza (2), bacterial pneumonia (2) and fever, myalgia and hypoxia. Two patients died at 3 and 5 months of gastrointestinal or hepatic GVHD occurring within 1 month of dosing. Responses included complete response (CR) (5), very good partial response (2), partial response (PR) (3), minimal response (1) and stable disease (2) for an overall response rate (⩾PR) of 56%. Ten patients discontinued therapy for progressive disease (PD) at a median of 8.5 (1–43) months. Six patients died from PD. Five patients remained on therapy at 39 months (range 14–57), with four in CR. Lenalidomide for relapse of MM after Allo-SCT can result in extended disease control (>12 months) in 50% of patients.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Bensinger W . Stem-cell transplantation for multiple myeloma in the era of novel drugs. J Clin Oncol 2008; 26: 480–492.
Schaapveld M, Visser O, Siesling S, Schaar CG, Zweegman S, Vellenga E . Improved survival among younger but not among older patients with multiple myeloma in the Netherlands, a population-based study since 1989. Eur J Cancer 2010; 46: 160–169.
Turesson I, Velez R, Kristinsson SY, Landgren O . Patterns of improved survival in patients with multiple myeloma in the twenty-first century: a population-based study. J Clin Oncol 2010; 28: 830–834.
Segeren CM, Sonneveld P, van der Holt B, Vellenga E, Croockewit AJ, Verhoef GE et al. Overall and event-free survival are not improved by the use of myeloablative therapy following intensified chemotherapy in previously untreated patients with multiple myeloma: a prospective randomized phase 3 study. Blood 2003; 101: 2144–2151.
Sahebi F, Shen Y, Thomas SH, Rincon A, Murata-Collins J, Palmer J et al. Late relapses following reduced intensity allogeneic transplantation in patients with multiple myeloma: a long-term follow-up study. Br J Haematol 2013; 160: 199–206.
Bensinger WI . Is there still a role for allogeneic stem-cell transplantation in multiple myeloma. Best Pract Res Clin Haematol 2007; 20: 783–795.
Bruno B, Rotta M, Patriarca F, Mordini N, Allione B, Carnevale-Schianca F et al. A comparison of allografting with autografting for newly diagnosed myeloma. N Engl J Med 2007; 356: 1110–1120.
Garban F, Attal M, Michallet M, Hulin C, Bourhis JH, Yakoub-Agha I et al. Prospective comparison of autologous stem cell transplantation followed by dose-reduced allograft (IFM99-03 trial) with tandem autologous stem cell transplantation (IFM99-04 trial) in high-risk de novo multiple myeloma. Blood 2006; 107: 3474–3480.
Krishnan A, Pasquini MC, Logan B, Stadtmauer EA, Vesole DH, Alyea E III et al. Autologous haemopoietic stem-cell transplantation followed by allogeneic or autologous haemopoietic stem-cell transplantation in patients with multiple myeloma (BMT CTN 0102): a phase 3 biological assignment trial. Lancet Oncol 2011; 12: 1195–1203.
Lokhorst HM, van der Holt B, Cornelissen JJ, Kersten MJ, van Oers M, Raymakers R et al. Donor versus no-donor comparison of newly diagnosed myeloma patients included in the HOVON-50 multiple myeloma study. Blood 2012; 119: 6219–6225.
Bjorkstrand B, Iacobelli S, Hegenbart U, Gruber A, Greinix H, Volin L et al. Tandem autologous/reduced-intensity conditioning allogeneic stem-cell transplantation versus autologous transplantation in myeloma: long-term follow-up. J Clin Oncol 2011; 29: 3016–3022.
van de Donk NW, Kroger N, Hegenbart U, Corradini P, San Miguel JF, Goldschmidt H et al. Prognostic factors for donor lymphocyte infusions following non-myeloablative allogeneic stem cell transplantation in multiple myeloma. Bone Marrow Transplant 2006; 37: 1135–1141.
Zeiser R, Bertz H, Spyridonidis A, Houet L, Finke J . Donor lymphocyte infusions for multiple myeloma: clinical results and novel perspectives (Review). Bone Marrow Transplant 2004; 34: 923–928.
Roddie C, Peggs KS . Donor lymphocyte infusion following allogeneic hematopoietic stem cell transplantation (Review). Expert Opin Biol Ther 2011; 11: 473–487.
Richardson P, Jagannath S, Hussein M, Berenson J, Singhal S, Irwin D et al. Safety and efficacy of single-agent lenalidomide in patients with relapsed and refractory multiple myeloma. Blood 2009; 114: 772–778.
Kneppers E, van der HB, Kersten MJ, Zweegman S, Meijer E, Huls G et al. Lenalidomide maintenance after nonmyeloablative allogeneic stem cell transplantation in multiple myeloma is not feasible: results of the HOVON 76 Trial. Blood 2011; 118: 2413–2419.
Minnema MC, van der Veer MS, Aarts T, Emmelot M, Mutis T, Lokhorst HM . Lenalidomide alone or in combination with dexamethasone is highly effective in patients with relapsed multiple myeloma following allogeneic stem cell transplantation and increases the frequency of CD4+Foxp3+ T cells. Leukemia 2009; 23: 605–607.
Coman T, Bachy E, Michallet M, Socié G, Uzunov M, Bourhis JH et al. Lenalidomide as salvage treatment for multiple myeloma relapsing after allogeneic hematopoietic stem cell transplantation: a report from the SFGM-TC. Haematologica 2012; 98: 776–783.
Bladé J, Samson D, Reece D, Apperley J, Björkstrand B, Gahrton G et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant. Br J Haematol 1998; 102: 1115–1123.
Wolschke C, Stubig T, Hegenbart U, Schonland S, Heinzelmann M, Hildebrandt Y et al. Postallograft lenalidomide induces strong NK cell-mediated antimyeloma activity and risk for T cell-mediated GvHD: Results from a phase I/II dose-finding study. Exp Hematol 2013; 41: 134–142.
El-Cheikh J, Crocchiolo R, Furst S, Ladaique P, Castagna L, Faucher C et al. Lenalidomide plus donor-lymphocytes infusion after allogeneic stem-cell transplantation with reduced-intensity conditioning in patients with high-risk multiple myeloma. Exp Hematol 2012; 40: 521–527.
Kroger N, Badbaran A, Lioznov M, Schwarz S, Zeschke S, Hildebrand Y et al. Post-transplant immunotherapy with donor-lymphocyte infusion and novel agents to upgrade partial into complete and molecular remission in allografted patients with multiple myeloma. Exp Hematol 2009; 37: 791–798.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
William Bensinger received research funding from Celgene for this trial. He has served as an advisor and a speaker for Celgene. Pam Becker has received research funding from Celgene. Nicholas Burwick and Damian Green report no conflicts of interest.
Additional information
Author contributions
WIB designed the study, analyzed the data and wrote the manuscript. PSB analyzed the data and edited the manuscript. DJG and NB edited the manuscript.
Rights and permissions
About this article
Cite this article
Bensinger, W., Green, D., Burwick, N. et al. A prospective study of lenalidomide monotherapy for relapse after Allo-SCT for multiple myeloma. Bone Marrow Transplant 49, 492–495 (2014). https://doi.org/10.1038/bmt.2013.219
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2013.219
Keywords
This article is cited by
-
Maintenance therapy after allogeneic hematopoietic stem cell transplantation for patients with multiple myeloma
International Journal of Hematology (2023)
-
90Y-labeled anti-CD45 antibody allogeneic hematopoietic cell transplantation for high-risk multiple myeloma
Bone Marrow Transplantation (2021)
-
Immunomodulatory drugs and the risk of serious infection in multiple myeloma: systematic review and meta-analysis of randomized and observational studies
Annals of Hematology (2018)
-
A View from the Plateau: Is There a Role for Allogeneic Stem Cell Transplantation in the Era of Highly Effective Therapies for Multiple Myeloma?
Current Hematologic Malignancy Reports (2017)