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Salvage therapy with lenalidomide and dexamethasone in patients with advanced AL amyloidosis refractory to melphalan, bortezomib, and thalidomide

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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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Acknowledgments

The authors would like to thank Dr. Leda Roggeri for the data management.

Funding

This work was supported by grants from the, Ministry of Health (Ricerca Finalizzata Malattie Rare), “Istituto Superiore di Sanità” (526D/63); Ministry of Research and University (2007AESFX2_003); and “Associazione Italiana per la Ricerca sul Cancro” Program “Harnessing tumor cell/microenvironment cross talk to treat mature B cell tumors”.

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Authors and Affiliations

  1. Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere scientifico (IRCCS) Policlinico San Matteo”, Pavia, Italy

    Giovanni Palladini, Paola Russo, Andrea Foli, Paolo Milani, Francesca Lavatelli, Laura Obici, Mario Nuvolone & Giampaolo Merlini

  2. Department of Biochemistry, University of Pavia, Viale Golgi, 19, 27100, Pavia, Italy

    Giovanni Palladini, Paola Russo, Andrea Foli, Paolo Milani, Francesca Lavatelli, Laura Obici, Mario Nuvolone & Giampaolo Merlini

  3. Medical Oncology Unit, Foundation “Istituto di Ricovero e Cura a Carattere scientifico (IRCCS) Policlinico San Matteo”, Pavia, Italy

    Silvia Brugnatelli

  4. Department of Internal Medicine, Foundation “Istituto di Ricovero e Cura a Carattere scientifico (IRCCS) Policlinico San Matteo”, Pavia, Italy

    Rosangela Invernizzi

Authors
  1. Giovanni Palladini
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  2. Paola Russo
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  3. Andrea Foli
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  4. Paolo Milani
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  5. Francesca Lavatelli
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  6. Laura Obici
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  7. Mario Nuvolone
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  8. Silvia Brugnatelli
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  9. Rosangela Invernizzi
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  10. Giampaolo Merlini
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Corresponding author

Correspondence to Giampaolo Merlini.

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Palladini, G., Russo, P., Foli, A. et al. Salvage therapy with lenalidomide and dexamethasone in patients with advanced AL amyloidosis refractory to melphalan, bortezomib, and thalidomide. Ann Hematol 91, 89–92 (2012). https://doi.org/10.1007/s00277-011-1244-x

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  • DOI: https://doi.org/10.1007/s00277-011-1244-x

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