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Successful Treatment of Low-Dose Lenalidomide Maintenance Therapy Followed by Second Autologous Peripheral Blood Stem Cell Transplantation in Heavily Treated Multiple Myeloma

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DOI: 10.4236/ijcm.2012.32022    2,809 Downloads   5,091 Views  

ABSTRACT

Recently, the prognosis of multiple myeloma has been improved by using high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ASCT), bortezomib, and immunomodulatory drugs including thalidomide and lenalidomide. On the other hand, treatment strategy remains difficult for refractory and relapse cases. Here, we report the successful treatment of low-dose lenalidomide maintenance therapy followed by salvage ASCT in a heavily treated patient with multiple myeloma. This 58-year-old woman with IgG-λ multiple myeloma had a 5th recurrence in June, 2011. It was 7 years post-diagnosis, and she had received conventional therapies such as VAD, MP therapy. Furthermore, the patient had already been treated with ASCT, bortezomib, and thalidomide therapy. At the 5th recurrence, she had extramedullary plasmacytoma in the left orbit. She initially received bortezomib and dexamethasone therapy as induction therapy. After peripheral blood stem cell collection, radiation therapy was performed. The patient then received a second ASCT. Three months later, the response was very good partial response. Finally, the patient was treated with 5 mg/day lenalidomide orally as a maintenance therapy, and she achieved stringent complete response after 2 months according to International Myeloma Working Group response criteria. Low-dose lenalidomide maintenance therapy might be also useful for ASCT as salvage therapy, although further studies are warranted.

Cite this paper

N. Sekiguchi, N. Takezako, T. Ishii, A. Nagata, S. Noto and A. Miwa, "Successful Treatment of Low-Dose Lenalidomide Maintenance Therapy Followed by Second Autologous Peripheral Blood Stem Cell Transplantation in Heavily Treated Multiple Myeloma," International Journal of Clinical Medicine, Vol. 3 No. 2, 2012, pp. 106-109. doi: 10.4236/ijcm.2012.32022.

References

[1] J. Koreth, C. S. Cutler and B. Djurvegovic, “High-Dose Therapy with Single Autologous Transplantation versus Chemotherapy for Newly Diagnosed Multiple Myeloma: A Systematic Review and meta-analysis of Randomized Controlled Trials,” Biology of Blood and Marrow Transplantation, Vol. 13, No. 2, 2007, pp.183-196. doi:10.1016/j.bbmt.2006.09.010
[2] I. Turesson, R. Velez and S. Y. Kristinsson, “Patterns of Improved Survival in Patients with Multiple Myeloma in the Twenty-First Century: A Population-Based Study,” Journal of Clinical Oncology, Vol. 28, No. 5, 2010, pp. 830-834. doi:10.1200/JCO.2009.25.4177
[3] R. L. Olin, D. T. Vogl and D. L. Porter, “Second Auto-SCT Is Safe and Effective Salvage Therapy for Relapsed Multiple Myeloma,” Bone Marrow Transplantation, Vol. 43, No. 5, 2009, pp.417-422. doi:10.1038/bmt.2008.334
[4] R. Fenk, V. Liese and F. Neubauer, “Predictive Factors for Successful Salvage High-Dose Therapy in Patients with Multiple Myeloma Relapsing after Autologous Blood Stem Cell Transplantation,” Leukemia and Lymphoma, Vol. 52, 2011, pp. 1455-1462. doi:10.3109/10428194.2011.575967
[5] F. Elice, R. Raimondi and A. Tosetto, “Prolonged Overall Survival with Second On-Demand Autologous Transplant in Multiple Myeloma,” American Journal of Hematology, Vol. 81, No. 6, 2006, pp. 426-431. doi:10.1002/ajh.20641
[6] S. K. Kumar, S. V. Rajkumar and A. Dispenzieri, “Improved Survival in Multiple Myeloma and the Impact of Novel Therapies,” Blood, Vol. 111, No. 5, 2008, pp. 2516-2520. doi:10.1182/blood-2007-10-116129
[7] A. Palumbo, P. Falco and M. T. Ambrosini, “Thalidomide plus Dexamethasone Is an Effective Salvage Regimen for Myeloma Patients Relapsing after Autologous Transplant,” European Journal of Haematology, Vol. 75, No. 5, 2005, pp. 391-395. doi:10.1111/j.1600-0609.2005.00533.x
[8] International Myeloma Working Group, “Criteria for the Classification of Monoclonal Gammopathies, Multiple Myeloma and Related Disorders: A Report of the International Myeloma Working Group,” British Journal of Haematology, Vol. 121, No. 5, 2003, pp. 749-757. doi:10.1046/j.1365-2141.2003.04355.x
[9] P. R. Greipp, J. San Miguel and B. G. M. Durie, “International Staging System for Multiple Myeloma,” Journal of Clinical Oncology, Vol. 23, No. 15, 2005, pp. 3412-3420. doi:10.1200/JCO.2005.04.242
[10] B. Barlogie, L. Smith, and R. Alexanian, “Effective Treatment of Advanced Multiple Myeloma Refractory to Alkylating Agent,” New England Journal of Medicine, Vol. 310, No. 21, 1984, pp.1353-1356. doi:10.1056/NEJM198405243102104
[11] A. Raymond, R. Alexanian and A. Haut, “Combination Chemotherapy with Different Melphalan Dose Regimens,” Journal of American Medical Association, Vol. 208, No. 9, 1969, pp. 1680-1685. doi:10.1001/jama.1969.03160090040009
[12] B. Barlogie, W. S. Velasquez and R. Alexanian, “Etoposide, Dexamethasone, Cytarabine, and Cisplatin in Vincristine, Doxorubicin, and Dexamethasone-Refractory Myeloma,” Journal of Clinical Oncology, Vol. 7, No. 10, 1989, pp. 1514-1517.
[13] N. Takezako, N. Sekiguchi and A. Nagata, “Conditioning for Autologous Stem Cell Transplantation by Combining Bortezomib and Dexamethasone with High-Dose Melphalan (BD-HDM) Is Feasible in Young Japanese Multiple Myeloma Patients,” Hematologica, Vol.96, No. 1, 2011, p. 93.
[14] B. G. Durie, J. L. Haroussaeu and J. S. Miguel, “International Uniform Response Criteria for Multiple Myeloma,” Leukemia, Vol. 20, No. 9, 2006, pp. 1467-1473. doi:10.1038/sj.leu.2404284
[15] R. Fonseca, P. L. Bergsagel and J. Drach, “International Myeloma Working Group Molecular Classification of Multiple Myeloma: Spotlight Review,” Leukemia, Vol. 23, No. 12, 2009, pp. 2210-2221. doi:10.1038/leu.2009.174
[16] S. K. Kumar, J. R. Mikhael and F. K. Buadi, “Management of Newly Diagnosed Symptomatic Multiple Myeloma:updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Guidelines,” Mayo Clinic Proceedings, Vol. 84, No. 12, 2009, pp. 1095-1110. doi:10.4065/mcp.2009.0603
[17] J. F. San Miguel, R. Schlag and N. K. Khuageva, “Bortezomib plus Melphalan and Prednisone for Initial Treatment of Multiple Myeloma,” New England Journal of Medicine, Vol. 359, No. 9, 2008, pp. 906-917. doi:10.1056/NEJMoa0801479
[18] M. Roussel, P. Moreau and A. Huynh, “Bortezomib and High-Dose Melphalan as Conditioning Regimen before Autologous Stem Cell Transplantation in Patients with de Novo Multiple Myeloma: A Phase 2 Study of the Intergroupe Francophone du Mye′lome (IFM),” Blood, Vol. 115, No. 1, 2010, pp. 32-37. doi:10.1182/blood-2009-06-229658
[19] L. K. Hicks, A.E. Haynes and D. E. Reece, “A Meta-Analysis and Systematic Review of Thalidomide for Patients with Previously Untreated Multiple Myeloma,” Cancer Treatment Reviews, Vol. 34, No. 5, 2008, pp. 442-452. doi:10.1016/j.ctrv.2008.02.003
[20] A. Z. Badros. “The Role of Maintenance Therapy in the Treatment of Multiple Myeloma,” Journal of the National Comprehensive Cancer Network, Vol. 8, Suppl. 1, 2010, pp. S21-S27.
[21] G. J. Morgan, W. M. Gregory and F. E. Davies, “The Role of Maintenance Thalidomide Therapy in Multiple Myeloma: MRC Myeloma IX Results and Meta-Analysis,” Blood, 2011, in Press.
[22] P. McCarthy, K. Owzar and K. Anderson, “A Phase III Randomized, Double-Blind Study of Maintenance Therapy with Lenalidomide (CC 5013) or Placebo Following Autologous Stem Cell Transplantation for Multiple Myeloma. CALGB, ECOG and BMT CTN 100104,” Hematologica, Vol. 96, No. 1, 2011, p. 23.
[23] T. Hideshima, D. Chauhan and Y. Shima, “Thalidomide and Its Analogs Overcome Drug Resistance of Human Multiple Myeloma Cells to Conventional Therapy,” Blood, Vol. 96, No. 9, 2000, pp. 2943-2950.
[24] L. G. Corral, P. A. Haslett and G. W. Muller, “Differential Cytokine Modulation and T Cell Activation by Two Distinct Classes of Thalidomide Analogues That Are Potent Inhibitors of TNF-Alpha,” Journal of Immunology, Vol. 163, No. 1, 1999, pp. 380-386.
[25] L. Lu, F. Payvandi and L. Wu, “The Anti-Cancer Drug Lenalidomide Inhibits Angiogenesis and Metastasis via Multiple Inhibitory Effects on Endothelial Cell Function in Normoxic and Hypoxic Conditions,” Microvascular Research, Vol. 77, No. 2, 2009, pp. 78-86. doi:10.1016/j.mvr.2008.08.003

  
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