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A phase 2 trial of lenalidomide, bortezomib, and dexamethasone in patients with relapsed and relapsed/refractory myeloma

Paul G. Richardson, Wanling Xie, Sundar Jagannath, Andrzej Jakubowiak, Sagar Lonial, Noopur S. Raje, Melissa Alsina, Irene M. Ghobrial, Robert L. Schlossman, Nikhil C. Munshi, Amitabha Mazumder, David H. Vesole, Jonathan L. Kaufman, Kathleen Colson, Mary McKenney, Laura E. Lunde, John Feather, Michelle E. Maglio, Diane Warren, Dixil Francis, Teru Hideshima, Robert Knight, Dixie-Lee Esseltine, Constantine S. Mitsiades, Edie Weller and Kenneth C. Anderson

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  • RE: A phase 2 trial of lenalidomide, bortezomib, and dexamethasone in patients with relapsed and relapsed/refractory myeloma
    • Jehan Dupuis, Haematologist Lymphoid malignancies unit, CHU Henri Mondor, Créteil, France
    • Other Contributors:
      • Corinne Haioun, Haematologist
      • Karim Belhadj, Haematologist

    Lenalidomide, bortezomib and dexamethasone for myeloma in first relapse after autologous stem cell transplantation

    We read with interest the paper by Richardson et al in the March 6, 2014 issue on phase II trial of lenalidomide, bortezomib and dexamethasone in relapsed/refractory multiple myeloma.1 Following the phase 1b study of this combination,2 we have chosen to apply this regimen in our institution in patients with a first relapse after autologous stem cell transplant (ASCT). Thirty one patients have been treated between 2009 and 2013. Patient characteristics are reported in table 1. The median time to relapse following ASCT was 26 months (range 4 to 99). Sixteen patients had been exposed to bortezomib, 17 to an IMID and 5 patients had received both. Only 3 patients had received neither bortezomib nor an IMID.

    The median number of cycles was 6. Responding patients received maintenance with lenalidomide or an allograft. There was one death (pneumonia) during cycle 1. Two patients received an allograft after 6 cycles. Responses were: Progression n=7 (23%), stable disease n= 2 (7%), PR n=8 (26%), CR + VGPR n=13 (43%) with an overall response rate of 69%.3 There was no difference in response rates according to the presence of a t(4 ;14), prior exposure to bortezomib or IMIDs or the initial ISS. Only 2/6 (33%) patients relapsing < 1 year after ASCT reached at least a partial response versus 20/25 (80%) in the others (p=0.0434, Fischer’s exact test).

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    Conflict of Interest:
    None declared.