Lenalidomide as a Potent Inducer of Graft Versus Leukemia Effect in Patients with Hematologic Malignancies at High Risk
- PDF / 486,898 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 55 Downloads / 162 Views
CORRESPONDENCE
Lenalidomide as a Potent Inducer of Graft Versus Leukemia Effect in Patients with Hematologic Malignancies at High Risk of Relapse Post Allogeneic Stem Cell Transplant M. Vinodhini1 • Sachin Punatar1,2 • Anant Gokarn1,2 • Lingaraj Nayak1,2 Avinash Bonda1,2 • Libin Mathew1 • Navin Khattry1,2
•
Received: 21 May 2020 / Accepted: 24 September 2020 Ó Indian Society of Hematology and Blood Transfusion 2020
There are limited treatment options for post allogeneic stem cell transplant (ASCT) relapse of hematological malignancies. Options include donor lymphocyte infusion (DLI), chemotherapy, second transplant, targeted therapies or combinations of these. DLI alone may not help due to time it takes for its graft versus leukemia (GVL) effects; it is effective only in about one-third patients [1]. Agents like nivolumab have been shown to induce GVL post ASCT without DLI [2, 3]. However, nivolumab is prohibitively expensive in India. Lenalidomide is an immunomodulator that induces effector T cells and has both anti-leukemia and lymphoma activity. It carries the advantage of being an oral drug and is inexpensive. We report outcomes of 3 patients with impending relapse post ASCT in whom lenalidomide was used for its immunomodulatory effects since no other treatment options were feasible.
therapy (Fig. 1, upper panel) including lenalidomide 10 mg daily as bridge to transplant (Fig. 1, middle panel); only toxicity was grade I skin rash. Post ASCT, MRD (day ? 36) was 0.5% (Fig. 1, middle panel); cyclosporine was stopped and lenalidomide 10 mg/day started on day ? 37. She developed fever and grade I skin rash with eosinophilia on day ? 40. After excluding infectious causes, immune fever was suspected; lenalidomide was stopped on day ? 42. Liver GVHD (Glucksberg grade I) was diagnosed on day ? 52; this required prednisolone and mycophenolate. Although liver GVHD resolved, skin GVHD gradually evolved to chronic GVHD for which sirolimus was started on day ? 79. Repeat bone marrow (day ? 92) showed MRD 0%. She subsequently had extramedullary relapse on day ? 190, which was treated with radiotherapy followed by 3 systemic therapies. At her last follow up (day ? 405), she alive and disease free.
Case 1 A 29 year old female with ulcerative colitis since past 15 years (treated with azathioprine for 13 years) developed secondary acute leukemia (mixed phenotype-T/Myeloid) with multiple cytogenetic abnormalities (TP 53 deletion, del 5q, ABL1 amplification and tri-tetrasomy of 7, 8, 11 and 21). Prior to ASCT, she had received multiple lines of
& Navin Khattry [email protected] 1
HSCT Unit, Department of Medical Oncology, Tata Memorial Centre ACTREC, Room no 211, Paymaster Shodhika, Kharghar, Navi Mumbai 410210, Maharashtra, India
2
Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
Case 2 A 17 year-old male with primary progressive Hodgkin lymphoma underwent MSD ASCT after failing 4 lines of systemic therapy (Fig. 1, upper panel). Pre ASCT, he had received lenalidomide (10/mg/day) with weekly dexamet
Data Loading...
