Azacitidine-lenalidomide (ViLen) combination yields a high response rate in higher risk myelodysplastic syndromes (MDS)—ViLen-01 protocol

Moshe Mittelman*, Kalman Filanovsky, Yishai Ofran, Hanna Rosenbaum, Pia Raanani, Andrei Braester, Neta Goldschmidt, Ilya Kirgner, Yair Herishanu, Chava Perri, Martin Ellis, Howard S. Oster, The Israel Myelodysplastic Syndrome Working Group (MDS-WG) for The Israel Myelodysplastic Syndrome Working Group (MDS-WG)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Azacitidine treatment is effective in higher risk MDS (HR-MDS), with less than 50 % response, lasting 2 years. Aza and lenalidomide (Len) have a potential synergistic effect. ViLen-01 phase IIa trial includes 6-month induction (Aza 75 mg/m2/day, days 1–5, Len 10 mg/day, days 6–21, every 28 days), 6-month consolidation (Aza 75 mg/m2/day, days 1–5, every 28 days), and 12-month maintenance (Len 10 mg/day, days 1–21, every 28 days). Response was evaluated according to IWG criteria. Totally, 25 patients enrolled, with an average of 76.3 years old (60–87), and 88 % with major comorbidities. Thirteen patients completed induction, 7 proceeded for consolidation, and 2 for maintenance. The overall response rate (ORR) was 72 % (18/25), with 6 (24 %) for CR, 3 (12 %) for marrow CR, and 9 (36 %) for hematologic improvement (HI). The 7 non-responding patients were on the study 3 days to 4.1 months. At 6 months, 4 of 6 evaluable patients achieved complete cytogenetic response and 2 with del (5q) at diagnosis. Adverse events (AEs) were as expected in these patients: grades III–IV, mainly hematologic—thrombocytopenia (20 patients) and neutropenia (13 patients). The common non-hematologic AEs were infections (14 patients), nausea (7), vomiting (7), diarrhea (7), and skin reactions (5). The median progression-free survival (PFS) was 12 ± 1.36 months, with median overall survival (OS) of 12 ± 1.7 months. Quality of life (FACT questionnaire) data were available for 12 patients with a tendency towards improved QoL. This trial with elderly HR-MDS patients with an expected poor prognosis demonstrates a high (72 %) response rate and a reasonable expected safety profile but a relatively short PFS and OS.

Original languageEnglish
Pages (from-to)1811-1818
Number of pages8
JournalAnnals of Hematology
Volume95
Issue number11
DOIs
StatePublished - 1 Oct 2016

Funding

FundersFunder number
Celgene

    Keywords

    • Azacitidine-lenalidomide
    • High-risk MDS
    • Myelodysplastic syndromes

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