Use of ixazomib, lenalidomide and dexamethasone in patients with relapsed amyloid light-chain amyloidosis.

Use of ixazomib, lenalidomide and dexamethasone in patients with relapsed amyloid light-chain amyloidosis.:

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Use of ixazomib, lenalidomide and dexamethasone in patients with relapsed amyloid light-chain amyloidosis.

Br J Haematol. 2020 Jan 26;:

Authors: Cohen OC, Sharpley F, Gillmore JD, Lachmann HJ, Sachchithanantham S, Mahmood S, Fontana M, Whelan CJ, Martinez-Naharro A, Kyriakou C, Rabin N, Popat R, Yong K, Cheesman S, Shah R, Hawkins PN, Wechalekar AD

Abstract

With improving outcomes in amyloid light-chain (AL) amyloidosis, there is a need to study novel agents in this setting. We report outcomes of 40 patients with relapsed AL amyloidosis treated with ixazomib + lenalidomide + dexamethasone (IRd). Haematological responses were assessed on an intention-to-treat basis at three months: complete response (CR) - 8 (20·5%), very good partial response (VGPR) - 8 (20·5%), partial response (PR) - 7 (17·9%) and no response (NR) - 16 (41·0%). One patient had missing data. Six patients subsequently improved response. Best responses were: CR - 10 (25·6%), VGPR - 8 (20·5%), PR - 7 (17·9%), NR - 14 (35·9%). Cardiac and renal organ responses occurred in 5·6% and 13·3% respectively. Median progession-free survival (PFS) was 17·0 months (95% CI 7·3-20·7 months), improving to 28·8 months (95% CI 20·6-37·0 months) in those achieving CR/VGPR. Median overall survival was 29·1 months (95% CI 24-33 months). Serious adverse events were seen in 14 (35·0%) patients inclusive of 15 admissions due to: infection (6/15, 40·0%), fluid overload (5/15, 33·3%), cardiac arrhythmia (2/15, 13·3%), renal dysfunction (1/15, 6·6%) and anaemia (1/15, 6·6%). In summary, IRd is an oral treatment option with a manageable toxicity profile leading to deep responses in 47% of patients with relapsed AL amyloidosis.

PMID: 31984481 [PubMed - as supplied by publisher]