Maintenance lenalidomide in combination with 5-azacitidine as post-remission therapy for acute myeloid leukaemia

Wei, A, Tan, P, Perruzza, S, Govindaraj, C, Fleming, S and Plebanski, M 2015, 'Maintenance lenalidomide in combination with 5-azacitidine as post-remission therapy for acute myeloid leukaemia', British Journal of Haematology, vol. 169, no. 2, pp. 199-210.


Document type: Journal Article
Collection: Journal Articles

Title Maintenance lenalidomide in combination with 5-azacitidine as post-remission therapy for acute myeloid leukaemia
Author(s) Wei, A
Tan, P
Perruzza, S
Govindaraj, C
Fleming, S
Plebanski, M
Year 2015
Journal name British Journal of Haematology
Volume number 169
Issue number 2
Start page 199
End page 210
Total pages 12
Publisher Wiley-Blackwell Publishing Ltd.
Abstract In this Phase 1b study, the safety and tolerability of maintenance therapy, comprising lenalidomide (025 mg, days 525) in combination with azacitidine (5075 mg/m2, days 15) every 28 d, was explored in 40 patients with acute myeloid leukaemia (AML) in complete remission after chemotherapy. Eligibility included AML in first complete remission (CR1) with adverse risk karyotype (n = 8), fms‐related tyrosine kinase 3‐internal tandem duplication (FLT3‐ITD) (n = 5), age ≥60 years (n = 31) or AML in second remission (CR2) (n = 14). Dose‐limiting toxicity was not reached. Common toxicities were haematological, infection, injection pain, constipation, fatigue and diarrhoea. In CR1, median relapse‐free (RFS) and overall survival (OS) was 12 and 20 months, respectively. In CR2, median RFS was 11 months, with median OS not yet reached. Among 29 patients with intermediate cytogenetic risk, RFS was 50% at 24 months. There were five patients with concomitant FLT3‐ITD and nucleophosmin (NPM1) mutation; none have relapsed and all are still alive after 1739 months. Maintenance lenalidomide/azacitidine augmented the function of cytotoxic T lymphocytes, particularly in patients with NPM1 mutation. The lenalidomide/azacitidine maintenance combination was effective in suppressing residual DNA (cytosine‐5‐)‐methyltransferase 3 alpha (DNMT3A)‐positive disease, resulting in sustained remission in patients with concurrent NPM1 mutation. Azacitidine/lenalidomide as maintenance therapy for high‐risk AML warrants further exploration.
Subject Immunology not elsewhere classified
Keyword(s) Acute myeloid leukaemia
Azacitidine
Immune effector
Lenalidomide
Maintenance
DOI - identifier 10.1111/bjh.13281
Copyright notice © 2015 John Wiley & Sons Ltd.
ISSN 0007-1048
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