• Efstathios Kastritis, Ioanna Dialoupi, Maria Gavriatopoulou, Maria Roussou, Nikolaos Kanellias, Despina Fotiou, Ioannis Ntanasis-Stathopoulos, Elektra Papadopoulou, Dimitrios C Ziogas, Kimon Stamatelopoulos, Efstathios Manios, Argyrios Ntalianis, Evangelos Eleutherakis-Papaiakovou, Asimina Papanikolaou, Magdalini Migkou, Aristea-Maria Papanota, Harikleia Gakiopoulou, Erasmia Psimenou, Maria Irini Tselegkidi, Ourania Tsitsilonis, Ioannis Kostopoulos, Evangelos Terpos, and Meletios A Dimopoulos.
• Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece.
• Blood Adv. 2019 Oct 22; 3 (20): 3002-3009.

AbstractBortezomib and dexamethasone with cyclophosphamide (CyBorD) or melphalan (BMDex) are commonly used primary treatments for light-chain (AL) amyloidosis, but limited data exist on bortezomib with immunomodulatory drug combinations. We report our experience with primary therapy with a bortezomib, lenalidomide, and dexamethasone (VRD) "light" regimen in 34 consecutive patients with AL amyloidosis. The majority (79%) had cardiac involvement, 15% and 23% were Mayo stage 3A and 3B, respectively, and 54% had renal involvement. After the first VRD cycle, 71% of patients achieved a hematologic response (44% at least very good partial response [VGPR]). On intent to treat, 11 (32%) achieved a complete response (of whom 5 of 11 were minimal residual disease [MRD] negative at 10-5), 17 (50%) a VGPR, and 2 (7%) a partial response. The 12-month survival was 73%. Starting lenalidomide dose was 5 mg in 86% of patients. Hematologic toxicity was mild; nonhematologic toxicities included rash (grade 3/4 [16%]), infections (grade ≥3 [12%]), constipation (grade ≥3 [9%]), and peripheral neuropathy (grade 2 [20%]); 37.5% of patients required lenalidomide dose reduction, 27% discontinued lenalidomide, 38% required bortezomib dose reduction, and 12% discontinued bortezomib. We compared VRD to CyBorD in 68 patients matched for Mayo stage and baseline difference between involved minus uninvolved serum free light chain levels, and observed a trend for deeper response at 3 and 6 months with VRD. In conclusion, VRD can be an active regimen for newly diagnosed patients with AL amyloidosis able to induce very deep hematologic responses at the expense of increased toxicity.© 2019 by The American Society of Hematology.

18 keywords...

hide…