Comparison of thalidomide and lenalidomide as therapy for myelofibrosis

Abstract

With the use of the International Working Group for Myelofibrosis Treatment andResearch consensus criteria, we reassessed the efficacy of thalidomide and lenalidomide in 125 patients with myelofibrosis treated in 3 consecutive phase 2 trials: 44 received single-agent thalidomide, 41 single-agent lenalidomide, and 40 a combination of lenalidomide plus prednisone. The thalidomide group included significantly more untreated patients and patients with performance status of 2. The Lenalidomide-based therapy produced higher efficacy (34%-38%) than thalidomide (16%; P ‫؍‬ .06). Responses to thalidomide were seen within 3-15 weeks, whereas responses to the lenalidomidebased therapy were also seen after a prolonged course of therapy (range, 2-45 weeks). Lenalidomide plus prednisone therapy resulted in significantly longer response duration (median, 34 months) than single-agent lenalidomide or thalidomide (median, 7 and 13 months, respectively; P ‫؍‬ .042). Fewer patients (P ‫؍‬ .001) discontinued the lenalidomide plus prednisone therapy (13%) because of side effects then patients on single-agents therapy (32%-39%). In conclusion, the combination of lenalidomide plus prednisone appears to be more effective and safer than single-agent thalidomide or lenalidomide. (Blood. 2011; 118(4):899-902)

Long‐term outcome of pomalidomide therapy in myelofibrosis

“…However, in a prospective multi-center study [8], the combination of lenalidomide and prednisone resulted in only 19% anemia response and 23% overall response. Regardless, the use of thalidomide or lenalidomide in MF is limited by the respective occurrence of peripheral neuropathy [12] and moderate to severe myelosuppression [8], in the majority of treated patients.…”

“…Lenalidomide (5-10 mg/day), with or without prednisone, also alleviated anemia in a similar proportion of patients with MF [3,8,9], and was most useful in the presence of del(5q) [10]. Two recent studies reassessed treatment response using the International Working Group for Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) criteria [11]; one study reported up to 38% response rate for lenalidomide plus prednisone therapy [12] whereas the other study reported 28% response rate for thalidomide-based therapy [13]. However, in a prospective multi-center study [8], the combination of lenalidomide and prednisone resulted in only 19% anemia response and 23% overall response.…”

“…However, in a prospective multi-center study [8], the combination of lenalidomide and prednisone resulted in only 19% anemia response and 23% overall response. Regardless, the use of thalidomide or lenalidomide in MF is limited by the respective occurrence of peripheral neuropathy [12] and moderate to severe myelosuppression [8], in the majority of treated patients.We have recently communicated the short-term results of two consecutive clinical trials using pomalidomide therapy for MF [4,14,15]. The maximum tolerated dose of pomalidomide in MF was 3 mg/day (dose-limiting toxicity was myelosuppression) but doses higher than 2 mg/day were associated with more myelosuppression and other toxicities and were not necessarily more effective [15].…”

Management of Myeloproliferative Neoplasms: From Academic Guidelines to Clinical Practice

“…Myelosuppression was the main toxicity, with 88% of the patients having grade 3 or higher hematologic toxicity in one trial [37]. With the use of the International Working GroupMyelofibrosis Research and Treatment (IWG-MRT) criteria [38], the efficacy of lenalidomide was reassessed in 81 patients treated in phase 2 trials at the MD Anderson Cancer Center [39]. The results were compared with those of patients who received thalidomide as a single agent.…”

Ruxolitinib for Myelofibrosis

“…However, recent studies suggest that it may be utilised in older individuals as well (14,15). Other therapeutic modalities (e.g., thalidomide, hydroxyurea, corticosteroids, anagrelide, androgens, splenectomy or spleen irradiation, transfusions, pirfenidone and suramin) are only palliative and do not provide a substantial improvement in survival rates (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”