A recent prospective randomized trial comparing standard-dose to high-dose melphalan in patients presenting with newly diagnosed AL-amyloidosis showed that oral melphalan-dexamethasone (M-dex) given monthly could be considered the current standard of care, with a median survival of 56 months (Jaccard, N Engl J Med 2007). The use of a combination of lenalidomide and dexamethasone has also been tested in patients with symptomatic AL-amyloidosis. The initial dose of lenalidomide at 25 mg/day was poorly tolerated. However, a 15 mg/day dose regimen was well tolerated and effective, with both hematologic and organ responses (Dispenzieri, Blood 2007 & Sanchorawala, Blood 2007). Combining M-dex with lenalidomide (M-dex-rev) could increase the response rate but the toxicity of this regimen is still unknown. Thus we have initiated a multicenter single-arm open-label phase I/II dose escalation study of lenalidomide administered in combination with M-dex. The primary endpoint was the incidence of dose limiting toxicities (DLT) during the first cycle of lenalidomide at a given dose level in order to determine the maximum tolerated dose (MTD). In addition to melphalan 0.18mg/kg/day from day 1–4 of each 28 day cycle and dexamethasone 40mg/day from day 1– 4 of each 28 day cycle, 3 cohorts of 3 subjects were successively exposed to escalating doses of lenalidomide (5, 10 and 15mg once daily on days 1–21 of a 28 day cycle). DLT was defined using National Cancer Institute (NCI) common toxicity criteria during the first 4 weeks of treatment (one cycle) as the following: at least grade 2 cardiac arrhythmia, at least grade 3 non hematologic toxicity, grade 4 neutropenia lasting >7 days or any other Grade 4 hematologic toxicity, or treatment delay due to toxicity that occurred during the first cycle. No DLT was observed among the first 3 patients treated at 5, 10 and 15 mg lenalidomide/day. 9 additional subjects will be enrolled at 15 mg/day to better define the safety profile and estimate the hematologic and organ response rate. Final results regarding both toxicity and efficacy will be presented during the meeting.

Topics:
amyloidosis, antigens, cd98 light chains, dexamethasone, lenalidomide, melphalan, toxic effect, hematotoxicity, immunoglobulin deposition disease, primary amyloidosis, cardiac arrhythmia

Disclosures: Moreau:celgene: Membership on an entity’s Board of Directors or advisory committees; orthobiotech jansen-cilag: Membership on an entity’s Board of Directors or advisory committees. Harousseau:celgene: Membership on an entity’s Board of Directors or advisory committees; orthobiotech jansen-cilag: Membership on an entity’s Board of Directors or advisory committees. Grosbois:celgene: Membership on an entity’s Board of Directors or advisory committees. Leblond:orthobiotech jansencilag: Membership on an entity’s Board of Directors or advisory committees. Alakl:celgene: Employment. Fermand:celgene: Membership on an entity’s Board of Directors or advisory committees; orthobiotech jansen-cilag: Membership on an entity’s Board of Directors or advisory committees. Off Label Use: lenalidomide, used in the treatment of AL-amyloidosis.

Author notes

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2008, The American Society of Hematology
2008
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