Results of a phase 2, multicenter, single-arm, open-label study of lenalidomide in pediatric patients with relapsed or refractory acute myeloid leukemia.

Creator(s)

Maureen M. O'Brien
Todd A. Alonzo
Todd M. Cooper
John E. Levine
Patrick A. Brown
Tamra Slone
Keith August, Children's Mercy HospitalFollow
Bouchra Benettaib
Noha Biserna
Jennifer Poon
Meera Patturajan
Nianhang Chen
Mathew Simcock
Linda Zimmerman
E Anders Kolb

Document Type

Article

Publication Date

7-2021

Identifier

DOI: 10.1002/pbc.28946

Abstract

Background: Outcomes after relapse remain poor in pediatric patients with acute myeloid leukemia (AML), and new therapeutic approaches are needed. Lenalidomide has demonstrated activity in adults with lower risk myelodysplastic syndromes and older adults with relapsed or refractory (R/R) AML.

Methods: In this phase 2 study (NCT02538965), pediatric patients with R/R AML who received two or more prior therapies were treated with lenalidomide (starting dose 2 mg/kg/day on days 1-21 of each 28-day cycle) for a maximum of 12 cycles. The primary endpoint was rate of complete response (CR) and CR with incomplete blood count recovery (CRi) within the first four cycles.

Results: Seventeen patients enrolled and received one or more dose of lenalidomide. Median age was 12 years (range 5-18 years), median white blood cell count was 3.7 × 109 /L, and median peripheral blood blast count was 1.0 × 109 /L. One patient (5.9%) with a complex karyotype including del(5q) achieved CRi after two cycles of lenalidomide. This responder proceeded to a second hematopoietic stem cell transplantation and has remained without evidence of disease for 3 years. All patients experienced one or more of grades 3-4 treatment-emergent adverse event (TEAE). The most common grades 3-4 TEAEs were thrombocytopenia (58.8%), febrile neutropenia (47.1%), anemia (41.2%), and hypokalemia (41.2%).

Conclusions: In this population of pediatric patients with R/R AML, safety data were consistent with the known safety profile of lenalidomide. As only one patient responded, further evaluation of lenalidomide at the dose and schedule studied is not warranted in pediatric AML, with the possible exception of patients with del(5q).

Journal Title

Pediatric blood & cancer

Volume

68

Issue

7

First Page

28946

Last Page

28946

Keywords

acute myeloid leukemia; lenalidomide; refractory; relapsed

Comments

Grant support

• Bristol Myers Squibb

Recommended Citation

O'Brien MM, Alonzo TA, Cooper TM, et al. Results of a phase 2, multicenter, single-arm, open-label study of lenalidomide in pediatric patients with relapsed or refractory acute myeloid leukemia. Pediatr Blood Cancer. 2021;68(7):e28946. doi:10.1002/pbc.28946