Salvage therapy with lenalidomide and dexamethasone in patients with advanced AL amyloidosis refractory to melphalan,bortezomib, and thalidomide |
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Authors: | Giovanni?Palladini Paola?Russo Andrea?Foli Paolo?Milani Francesca?Lavatelli Laura?Obici Mario?Nuvolone Silvia?Brugnatelli Rosangela?Invernizzi Email author" target="_blank">Giampaolo?MerliniEmail author |
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Institution: | (1) Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere scientifico (IRCCS) Policlinico San Matteo”, Pavia, Italy;(2) Department of Biochemistry, University of Pavia, Viale Golgi, 19, 27100 Pavia, Italy;(3) Medical Oncology Unit, Foundation “Istituto di Ricovero e Cura a Carattere scientifico (IRCCS) Policlinico San Matteo”, Pavia, Italy;(4) Department of Internal Medicine, Foundation “Istituto di Ricovero e Cura a Carattere scientifico (IRCCS) Policlinico San Matteo”, Pavia, Italy;(5) University of Pavia, Pavia, Italy |
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Abstract: | The increasing number of effective agents allows rescue therapy of patients with light-chain (AL) amyloidosis refractory to
≥2 previous treatments. Lenalidomide is effective in this disease and its toxicity profile encourages its use in salvage regimens.
All the patients with AL amyloidosis refractory to both melphalan and bortezomib referred to our center between July 2007
and July 2009 were treated with the combination of lenalidomide and dexamethasone. Twenty-four consecutive patients were enrolled.
Seventy-nine percent were also refractory to thalidomide. Two patients died before evaluation of response, and 50% experienced
severe adverse events. Survival was significantly shorter in subjects with troponin I >0.1 ng/mL and in patients diagnosed
<18 months before treatment initiation. Hematologic response was observed in 41% of patients and prolonged survival (median
10 months vs. not reached, P = 0.005) independently from troponin I concentration and from pre-treatment disease duration. Salvage therapy beyond second
line of treatment can improve survival in AL amyloidosis and lenalidomide plus dexamethasone is a valuable option in this
setting. |
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