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Allografting

Toxicity-reduced, myeloablative allograft followed by lenalidomide maintenance as salvage therapy for refractory/relapsed myeloma patients

Bone Marrow Transplantation volume 48, pages 403–407 (2013)Cite this article

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Abstract

Relapse after dose-reduced allograft in advanced myeloma patients remains high. To reduce the risk of relapse, we investigated a myeloablative toxicity-reduced allograft (aSCT) consisting of i.v. BU and CY followed by lenalidomide maintenance therapy in 33 patients with multiple myeloma (MM) who relapsed following an autograft after a median of 12 months. The cumulative incidence of non-relapse mortality at 1 year was 6% (95% confidence interval (CI): 0–14). After a median interval of 168 days following aSCT, 24 patients started with a median dose of 5 mg (r, 5–15) lenalidomide without dexamethasone. During follow-up, 13 patients discontinued lenalidomide owing to progressive disease (n=6), GvHD (n=3), thrombocytopenia (n=2), or fatigue (n=2). Major toxicities of lenalidomide were GvHD II–III (28%), viral reactivation (16%), thrombocytopenia (III–IV°,16%), neutropenia (III/IV°, 8%), peripheral neuropathy (I/II°, 16%), or other infectious complication (8%). Cumulative incidence of relapse at 3 years was 42% (95% CI: 18–66). The 3-year estimated probability of PFS and OS was 52% (95% CI: 28–76) and 79% (95% CI: 63–95), respectively. Toxicity-reduced myeloablative allograft followed by lenalidomide maintenance is feasible and effective in relapsed patients with MM, but the induction of GvHD should be considered.

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Acknowledgements

NK received research funding from Celgene. MK and GS received honorarium from Celgene.

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Authors and Affiliations

  1. Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    N Kröger, T Zabelina, E Klyuchnikov, T Stübig, C Wolschke, F Ayuk, Y Hildebrandt, U Bacher, A Badbaran & A R Zander

  2. Department of Oncology/Hematology, University Medical Center, Münster, Germany

    M Kropff

  3. Department of Oncology/Hematology DIAKO Hospital, Bremen, Germany

    K-H Pflüger

  4. Department of Oncology/Hematology, University Hospital Marburg, Marburg, Germany

    A Burchert

  5. Department of Oncology/Hematology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    G Schilling, T Hansen & D Atanackovic

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  1. N Kröger
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Correspondence to N Kröger.

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Kröger, N., Zabelina, T., Klyuchnikov, E. et al. Toxicity-reduced, myeloablative allograft followed by lenalidomide maintenance as salvage therapy for refractory/relapsed myeloma patients. Bone Marrow Transplant 48, 403–407 (2013). https://doi.org/10.1038/bmt.2012.142

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