ABSTRACT
Optimal salvage treatment for multiple myeloma relapsing after allogeneic stem cell transplantation remains to be determined. Usually, such patients have been heavily pre-treated and present at relapse with a relatively refractory disease. Immunomodulatory properties of lenalidomide may be beneficial by facilitating a graft-versus-myeloma effect after allogeneic stem cell transplantation. However, the safety of such treatment is still under debate. We conducted a multicenter retrospective study and included 52 myeloma patients receiving lenalidomide alone or in combination with dexamethasone as salvage therapy after allogeneic stem cell transplantation. The first aim was to assess the efficacy and tolerance of this drug. The second aim was to evaluate its potential immunomodulatory effects evaluated on the occurrence of acute graft-versus-host disease under treatment. In this cohort, we show that lenalidomide can induce a high response rate of 83% (including 29% complete response). On lenalidomide therapy, 16 patients (31%) developed or exacerbated an acute graft-versus-host disease, which was the only factor significantly associated with an improved anti-myeloma response. Side effects were mostly reversible, whereas 2 deaths (4%) could be attributed to treatment toxicity and to graft-versus-host disease, respectively. With a median follow up of 16.3 months, the median overall and progression free survival were 30.5 and 18 months, respectively, independently of the occurrence of acute graft-versus-host disease under lenalidomide. Lenalidomide can induce high response rates in myeloma relapsing after allogeneic stem cell transplantation at least in part by triggering an allogeneic anti-myeloma response. Induced graft-versus-host disease has to be balanced against the potential benefit in terms of disease control. Further immunological studies would help us understand lenalidomide immunomodulatory activity in vivo.
Subject(s)
Antineoplastic Agents/therapeutic use , Multiple Myeloma/drug therapy , Thalidomide/analogs & derivatives , Adult , Antineoplastic Agents/adverse effects , Female , France , Graft vs Host Disease/drug therapy , Graft vs Host Disease/etiology , Hematopoietic Stem Cell Transplantation , Humans , Lenalidomide , Male , Middle Aged , Multiple Myeloma/mortality , Multiple Myeloma/surgery , Recurrence , Retrospective Studies , Salvage Therapy , Thalidomide/adverse effects , Thalidomide/therapeutic use , Transplantation, Homologous , Treatment OutcomeABSTRACT
CASE REPORT: We report 2 cases of orbital plasmacytoma in patients with known multiple myeloma. Orbital spread with secondary maxillary sinus involvement is reported in the first case. Case 2 is the first report of immunoglobulin A kappa light chain multiple myeloma involving orbital recti muscles. Computed axial tomography and magnetic resonance imaging aided the diagnosis, confirmed with histopathologic studies. COMMENTS: Extraskeletal spread is rare and orbital involvement is exceedingly uncommon. From a review of the literature since 1972, we conclude that the immunoglobulin G type of multiple myeloma, whether lambda or kappa light chain, may be a risk factor for orbital involvement.
Subject(s)
Multiple Myeloma/diagnosis , Oculomotor Muscles/diagnostic imaging , Oculomotor Muscles/pathology , Orbital Neoplasms/diagnosis , Aged , Biopsy , Diagnosis, Differential , Fatal Outcome , Female , Humans , Immunoglobulin A/metabolism , Immunoglobulin kappa-Chains/metabolism , Immunohistochemistry , Magnetic Resonance Imaging , Middle Aged , Multiple Myeloma/metabolism , Orbital Neoplasms/metabolism , Risk Factors , Tomography, X-Ray ComputedABSTRACT
UNLABELLED: Adult T-cell leukemia-lymphoma (ATLL) has a very bad prognosis and remains resistant to conventional therapy. Promising results have been reported with the combination of zidovudine (AZT) and alpha-interferon (IFN). METHOD: A combination with IFN and antinucleoside [AZT or zalcitabine (ddC)] was applied since 1995 in Martinique (French West Indies). An initial treatment with two cycles of CHOP was added to reduce initial tumoral burden, followed by antiretroviral (ARV) therapy associated with etoposide. We report the characteristics and outcomes of 29 patients diagnosed with an ATLL between 1990 and 1999. The overall median survival was 8 months. A striking improvement of survival was observed when comparing the periods between 1990-1994 and 1995-1999 (17 months versus 3 months, p = 0.004). During the second period, seven patients received a therapy with oral etoposide, antinucleoside and IFN, among which, six patients received an initial induction CHOP chemotherapy. No major toxicity was observed with this strategy. In conclusion, the progression of survival since 1995 suggests that a therapeutic approach combining initial polychemotherapy with CHOP followed by ARV drugs, IFN and oral etoposide is an interesting option in treating patients with ATLL.
