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Polyclonal immune activation and marrow plasmacytosis in multiple myeloma patients receiving long-term lenalidomide therapy: incidence and prognostic significance

Leukemia volume 27, pages 2422–2424 (2013)Cite this article

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The introduction of the immunomodulatory drug lenalidomide has significantly improved response rates and survival in patients with multiple myeloma (MM).1, 2 Recently, two studies by the French IFM and the US CALGB groups have investigated maintenance lenalidomide after autologous stem cell transplantation (ASCT), and demonstrated significant improvement in the progression-free survival (PFS) with significant overall survival benefit reported by the CALGB study.3, 4 Likewise, a randomized study by the Italian Myeloma Network demonstrated a significant prolongation of PFS in elderly patients not eligible for ASCT who received lenalidomide maintenance.5 On the basis of these studies, maintenance lenalidomide has been widely adopted in the myeloma community.

Lenalidomide exerts its effects through a multitude of complex mechanisms of action. Extensive investigations have revealed that it has direct anti-tumor activity by targeting cellular cytoskeletal organization, cell cycle, inhibition of oncogenes, induction of tumor suppressor genes, activation of apoptotic pathways and inhibition of angiogenesis, and it also exerts complex immunomodulatory effects on the tumor microenvironment.6, 7 These mechanisms lead to various biological phenotypes, some of which have not yet been fully elucidated.

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References

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Acknowledgements

DZ, SG and HH received research funding from Celgene.

Author contributions

DZ and HH designed the study, collected and analyzed the data and wrote the manuscript. DC, JW, DB, collected the data. SD, SG, HL, NL, AL, MA and DC analyzed the data and assisted in manuscript preparation.

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Authors and Affiliations

  1. Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA

    D Zamarin, H Landau, A Lesokhin, N Lendvai, D J Chung, D Chimento, J Weltz, S Giralt & H Hassoun

  2. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA

    S M Devlin

  3. Department of Pathology, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA

    M E Arcila

  4. Department of Internal Medicine, St Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA

    D Babu

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  1. D Zamarin
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  11. S Giralt
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  12. H Hassoun
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Corresponding author

Correspondence to H Hassoun.

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Zamarin, D., Devlin, S., Arcila, M. et al. Polyclonal immune activation and marrow plasmacytosis in multiple myeloma patients receiving long-term lenalidomide therapy: incidence and prognostic significance. Leukemia 27, 2422–2424 (2013). https://doi.org/10.1038/leu.2013.126

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