Difference between revisions of "Plasma cell leukemia"

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'''Use of this site is subject to you reading and agreeing with the terms set forth in the [[HemOnc.org_-_A_Hematology_Oncology_Wiki:General_disclaimer|disclaimer]].'''
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<span id="BackToTop"></span>
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<div class="noprint" style="background-color:LightGray; position:fixed; bottom:2%; right:0.25%; padding-left:5px; padding-right:5px; margin: 15px; opacity:0.8; border-style: solid; border-color:DarkGray; border-width: 1px">
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Is there a regimen missing from this list?  Would you like to share a different dosage/schedule or an additional reference for a regimen?  Have you noticed an error?  Do you have an idea that will help the site grow to better meet your needs and the needs of many others?  You are [[How_to_contribute|invited to contribute to the site]] ''Are you looking for a regimen but can't find it here? It is possible that we've moved it to the [[Multiple_myeloma_-_obsolete|obsolete regimens page]]. If you still can't find it, please let us know so we can add it!''.
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[[#top|Back to Top]]
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{{#lst:Editorial board transclusions|pcd}}
 
{| class="wikitable" style="float:right; margin-right: 5px;"
 
{| class="wikitable" style="float:right; margin-right: 5px;"
 
|-
 
|-
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|<div style="background-color: #66FF66; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Regimen |limit=10000|format=sum}} regimens on this page</b></font></div>
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|<div style="background-color: #fee0d1; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Regimen |limit=10000|format=sum}} [[Tutorial#Regimens|regimens]] on this page</b></font></div>
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<div style="background-color: #66CCFF; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Variant |limit=10000|format=sum}} variants on this page</b></font></div>
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<div style="background-color: #deebf6; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Variant |limit=10000|format=sum}} [[Tutorial#Variants|variants]] on this page</b></font></div>
 
|}
 
|}
 
{{TOC limit|limit=3}}
 
{{TOC limit|limit=3}}
 +
=Guidelines=
 +
'''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.'''
 +
==EMN==
 +
*'''2018:''' Gavriatopoulou et al. [https://doi.org/10.1038/s41375-018-0209-7 European myeloma network recommendations on diagnosis and management of patients with rare plasma cell dyscrasias] [https://pubmed.ncbi.nlm.nih.gov/30038381/ PubMed]
 +
==IMWG==
 +
*'''2012:''' de Larrea et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112539/ Consensus Statement on Diagnostic Requirements, Response Criteria, and Treatment Recommendations by the International Myeloma Working Group (IMWG)] [https://pubmed.ncbi.nlm.nih.gov/23288300/ PubMed]
  
−
=Untreated=
+
=First-line therapy=
−
 
 
−
==Ld {{#subobject:dc6eae|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
−
Ld: '''<u>L</u>'''enalidomide, low dose '''<u>d</u>'''examethasone
 
−
 
 
−
===Regimen {{#subobject:be34d7|Variant=1}}===
 
−
{| border="1" style="text-align:center;" !align="left"
 
−
|'''Study'''
 
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
 
−
|-
 
−
|[http://www.nature.com/leu/journal/v28/n1/full/leu2013241a.html Musto et al. 2013]
 
−
|style="background-color:#EEEE00"|Phase II
 
−
|-
 
−
|}
 
−
====Chemotherapy====
 
−
*[[Lenalidomide (Revlimid)]] 25 mg PO once per day on days 1 to 21
 
−
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1, 8, 15, 22
 
−
 
 
−
'''28-day cycle for 4 cycles'''
 
−
 
 
−
''Responding patients eligible for transplant proceeded to SCT per center protocol. Responding patients ineligible for transplant received 4 more cycles of Ld, followed by [[#Lenalidomide_.28Revlimid.29|lenalidomide maintenance]].''
 
−
 
 
−
===References===
 
−
# Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia. 2014 Jan;28(1):222-5. Epub 2013 Aug 20. [http://www.nature.com/leu/journal/v28/n1/full/leu2013241a.html link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/23958922 PubMed]
 
−
 
 
 
==PAD/VCD {{#subobject:cc293b|Regimen=1}}==
 
==PAD/VCD {{#subobject:cc293b|Regimen=1}}==
−
{| class="wikitable" style="float:right; margin-left: 5px;"
+
PAD/VCD: '''<u>P</u>'''S-341 (Bortezomib), '''<u>A</u>'''driamycin liposomal (Pegylated liposomal doxorubicin), '''<u>D</u>'''examethasone alternating with '''<u>V</u>'''elcade (Bortezomib), '''<u>C</u>'''yclophosphamide, '''<u>D</u>'''examethasone
−
|-
+
<div class="toccolours" style="background-color:#eeeeee">
−
|[[#top|back to top]]
 
−
|}
 
−
PAD: '''<u>P</u>'''S-341 (Bortezomib), '''<u>A</u>'''driamycin liposomal (Doxorubicin liposomal), '''<u>D</u>'''examethasone
 
−
<br>VCD: '''<u>V</u>'''elcade (Bortezomib), '''<u>C</u>'''yclophosphamide, '''<u>D</u>'''examethasone
 
−
 
 
 
===Regimen {{#subobject:9763fb|Variant=1}}===
 
===Regimen {{#subobject:9763fb|Variant=1}}===
−
{| border="1" style="text-align:center;" !align="left"  
+
{| class="wikitable sortable" style="width: 60%; text-align:center;"  
−
|'''Study'''
+
!style="width: 33%"|Study
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+
!style="width: 33%"|Dates of enrollment
 +
!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
|-
 
|-
−
|[http://jco.ascopubs.org/content/34/18/2125.full Royer et al. 2016]
+
|[https://doi.org/10.1200/jco.2015.63.1929 Royer et al. 2016]
−
|style="background-color:#EEEE00"|Phase II
+
|2010-04 to 2013-07
 +
|style="background-color:#91cf61"|Phase 2
 
|-
 
|-
 
|}
 
|}
−
====PAD portion====
+
<div class="toccolours" style="background-color:#b3e2cd">
−
*[[Bortezomib (Velcade)]] 1.3 mg/m<sup>2</sup> SC once per day on days 1, 4, 8, 11
+
====Targeted therapy, both portions (cycles 1 to 4)====
−
*[[Doxorubicin liposomal (Doxil)]] 30 mg/m<sup>2</sup> IV once on day 4
 
−
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1, 4, 8, 11
 
−
 
 
−
'''Two 21-day cycles (1 & 3), alternating with VCD'''
 
−
 
 
−
====VCD portion====
 
 
*[[Bortezomib (Velcade)]] 1.3 mg/m<sup>2</sup> SC once per day on days 1, 4, 8, 11
 
*[[Bortezomib (Velcade)]] 1.3 mg/m<sup>2</sup> SC once per day on days 1, 4, 8, 11
 +
====Chemotherapy, PAD portion (cycles 1 & 3)====
 +
*[[Pegylated liposomal doxorubicin (Doxil)]] 30 mg/m<sup>2</sup> IV once on day 4
 +
====Chemotherapy, VCD portion (cycles 2 & 4)====
 
*[[Cyclophosphamide (Cytoxan)]] 300 mg/m<sup>2</sup> PO once per day on days 1 & 8
 
*[[Cyclophosphamide (Cytoxan)]] 300 mg/m<sup>2</sup> PO once per day on days 1 & 8
 +
====Glucocorticoid therapy, both portions (cycles 1 to 4)====
 
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1, 4, 8, 11
 
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1, 4, 8, 11
−
 
+
'''21-day cycle for 4 cycles'''
−
'''Two 21-day cycles (2 & 4), alternating with PAD'''
+
</div>
−
 
+
<div class="toccolours" style="background-color:#cbd5e7">
−
''Responding patients proceeded to undergo  [[#Melphalan_-.3E_autologous_stem_cell_transplant|high-dose melphalan & autologous stem cell transplant]].''
+
====Subsequent treatment====
−
 
+
*Royer et al. 2016, responding patients: [[#Melphalan_monotherapy.2C_then_auto_HSCT|High-dose melphalan & autologous HSCT]] consolidation
 +
</div></div>
 
===References===
 
===References===
 
<!-- Presented at the 55th American Society of Hematology Annual Meeting, New Orleans, LA, December 7-10, 2013, and the 40th Annual Meeting of the European Society for Blood and Marrow Transplantation, Milan, Italy, March 30 to April 2, 2014. -->
 
<!-- Presented at the 55th American Society of Hematology Annual Meeting, New Orleans, LA, December 7-10, 2013, and the 40th Annual Meeting of the European Society for Blood and Marrow Transplantation, Milan, Italy, March 30 to April 2, 2014. -->
−
# Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol. 2016 Jun 20;34(18):2125-32. Epub 2016 Apr 25. [http://jco.ascopubs.org/content/34/18/2125.full link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/27114594 PubMed]
+
# Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP; IFM. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol. 2016 Jun 20;34(18):2125-32. Epub 2016 Apr 25. [https://doi.org/10.1200/jco.2015.63.1929 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/27114594/ PubMed] EudraCT 2009-016607-33
  
−
=Consolidation after upfront therapy=
+
==Lenalidomide & Dexamethasone (Rd) {{#subobject:dc6eae|Regimen=1}}==
−
 
+
Rd: '''<u>R</u>'''evlimid (Lenalidomide) & low-dose '''<u>d</u>'''examethasone
−
==Melphalan -> autologous stem cell transplant {{#subobject:5cf2b0|Regimen=1}}==
+
<br>RevDex: '''<u>Rev</u>'''limid (Lenalidomide) & '''<u>Dex</u>'''amethasone
−
{| class="wikitable" style="float:right; margin-left: 5px;"
+
<br>Ld: '''<u>L</u>'''enalidomide & low-dose '''<u>d</u>'''examethasone
 +
<br>LenDex: '''<u>L</u>'''enalidomide & '''<u>D</u>'''examethasone
 +
<div class="toccolours" style="background-color:#eeeeee">
 +
===Regimen {{#subobject:be34d7|Variant=1}}===
 +
{| class="wikitable sortable" style="width: 60%; text-align:center;"  
 +
!style="width: 33%"|Study
 +
!style="width: 33%"|Dates of enrollment
 +
!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 +
|-
 +
|[https://doi.org/10.1038/leu.2013.241 Musto et al. 2013]
 +
|2009-03-01 to 2011-05-31
 +
|style="background-color:#91cf61"|Phase 2
 
|-
 
|-
−
|[[#top|back to top]]
 
 
|}
 
|}
−
 
+
<div class="toccolours" style="background-color:#b3e2cd">
 +
====Targeted therapy====
 +
*[[Lenalidomide (Revlimid)]] 25 mg PO once per day on days 1 to 21
 +
====Glucocorticoid therapy====
 +
*[[Dexamethasone (Decadron)]] 40 mg PO once per day on days 1, 8, 15, 22
 +
'''28-day cycle for 4 cycles'''
 +
</div>
 +
<div class="toccolours" style="background-color:#cbd5e7">
 +
====Subsequent treatment====
 +
*Musto et al. 2013, responding patients eligible for transplant: HSCT consolidation per center protocol
 +
*Musto et al. 2013, responding patients ineligible for transplant: [[#Lenalidomide_.26_Dexamethasone_.28Rd.29|Rd]] consolidation x 4 (8 cycles total), then [[#Lenalidomide_monotherapy|lenalidomide]] maintenance
 +
</div></div>
 +
===References===
 +
# Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia. 2014 Jan;28(1):222-5. Epub 2013 Aug 20. [https://doi.org/10.1038/leu.2013.241 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/23958922/ PubMed]
 +
=Consolidation after first-line therapy=
 +
==Melphalan monotherapy, then auto HSCT {{#subobject:5cf2b0|Regimen=1}}==
 +
<div class="toccolours" style="background-color:#eeeeee">
 
===Regimen {{#subobject:e8054d|Variant=1}}===
 
===Regimen {{#subobject:e8054d|Variant=1}}===
−
{| border="1" style="text-align:center;" !align="left"  
+
{| class="wikitable sortable" style="width: 60%; text-align:center;"  
−
|'''Study'''
+
!style="width: 33%"|Study
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+
!style="width: 33%"|Dates of enrollment
 +
!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
|-
 
|-
−
|[http://jco.ascopubs.org/content/34/18/2125.full Royer et al. 2016]
+
|[https://doi.org/10.1200/jco.2015.63.1929 Royer et al. 2016]
−
|style="background-color:#EEEE00"|Phase II
+
|2010-04 to 2013-07
 +
|style="background-color:#91cf61"|Phase 2
 
|-
 
|-
 
|}
 
|}
−
''Treatment preceded by [[#PAD.2FVCD|PAD alternating with VCD]].''
+
<div class="toccolours" style="background-color:#cbd5e8">
 +
====Preceding treatment====
 +
*Upfront [[#PAD.2FVCD|PAD alternating with VCD]]
 +
</div>
 +
<div class="toccolours" style="background-color:#b3e2cd">
 
====Chemotherapy====
 
====Chemotherapy====
−
*[[Melphalan (Alkeran)]] 200 mg/m<sup>2</sup> IV once
+
*[[Melphalan (Alkeran)]] IV once (day not specified) by the following age- and renal function-based criteria:
−
**Patients > 65 years or with CrCl < 30 mL/min received 140 mg/m2
+
**65 years old or younger AND CrCl 30 mL/min/1.73m<sup>2</sup> or more: 200 mg/m<sup>2</sup>
−
 
+
**Older than 65 years old OR CrCl less than 30 mL/min/1.73m<sup>2</sup>: 140 mg/m<sup>2</sup>
 +
'''1 or 2 courses'''
 +
</div></div>
 
===References===
 
===References===
 
<!-- Presented at the 55th American Society of Hematology Annual Meeting, New Orleans, LA, December 7-10, 2013, and the 40th Annual Meeting of the European Society for Blood and Marrow Transplantation, Milan, Italy, March 30 to April 2, 2014. -->
 
<!-- Presented at the 55th American Society of Hematology Annual Meeting, New Orleans, LA, December 7-10, 2013, and the 40th Annual Meeting of the European Society for Blood and Marrow Transplantation, Milan, Italy, March 30 to April 2, 2014. -->
−
# Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol. 2016 Jun 20;34(18):2125-32. Epub 2016 Apr 25. [http://jco.ascopubs.org/content/34/18/2125.full link to original article] '''contains protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/27114594 PubMed]
+
# Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol. 2016 Jun 20;34(18):2125-32. Epub 2016 Apr 25. [https://doi.org/10.1200/jco.2015.63.1929 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/27114594/ PubMed] EudraCT 2009-016607-33
−
 
 
−
=Maintenance therapy=
 
−
 
 
−
==Lenalidomide (Revlimid) {{#subobject:bec321|Regimen=1}}==
 
−
{| class="wikitable" style="float:right; margin-left: 5px;"
 
−
|-
 
−
|[[#top|back to top]]
 
−
|}
 
  
 +
=Maintenance after first-line therapy=
 +
==Lenalidomide monotherapy {{#subobject:bec321|Regimen=1}}==
 +
<div class="toccolours" style="background-color:#eeeeee">
 
===Regimen {{#subobject:45c352|Variant=1}}===
 
===Regimen {{#subobject:45c352|Variant=1}}===
−
{| border="1" style="text-align:center;" !align="left"  
+
{| class="wikitable sortable" style="width: 60%; text-align:center;"  
−
|'''Study'''
+
!style="width: 33%"|Study
−
|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+
!style="width: 33%"|Dates of enrollment
 +
!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
|-
 
|-
−
|[http://www.nature.com/leu/journal/v28/n1/full/leu2013241a.html Musto et al. 2013]
+
|[https://doi.org/10.1038/leu.2013.241 Musto et al. 2013]
−
|style="background-color:#EEEE00"|Phase II
+
|2009-03-01 to 2011-05-31
 +
|style="background-color:#91cf61"|Phase 2
 
|-
 
|-
 
|}
 
|}
−
 
+
<div class="toccolours" style="background-color:#cbd5e8">
−
''Treatment preceded by [[#Ld|Ld]] x 8.''
+
====Preceding treatment====
−
====Chemotherapy====
+
*Upfront [[#Lenalidomide_.26_Dexamethasone_.28Rd.29|Rd]] x 8
 +
</div>
 +
<div class="toccolours" style="background-color:#b3e2cd">
 +
====Targeted therapy====
 
*[[Lenalidomide (Revlimid)]] 10 mg PO once per day on days 1 to 21
 
*[[Lenalidomide (Revlimid)]] 10 mg PO once per day on days 1 to 21
−
 
+
'''28-day cycles'''
−
'''28-day cycles until progression'''
+
</div></div>
−
 
 
 
===References===
 
===References===
−
# Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia. 2014 Jan;28(1):222-5. Epub 2013 Aug 20. [http://www.nature.com/leu/journal/v28/n1/full/leu2013241a.html link to original article] '''contains verified protocol''' [https://www.ncbi.nlm.nih.gov/pubmed/23958922 PubMed]
+
# Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia. 2014 Jan;28(1):222-5. Epub 2013 Aug 20. [https://doi.org/10.1038/leu.2013.241 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/23958922/ PubMed]
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+
[[Category:Plasma cell leukemia regimens]]
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[[Category:Chemotherapy regimens]]
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[[Category:Disease-specific pages]]
−
[[Category:Malignant hematology regimens]]
+
[[Category:Plasma cell dyscrasias]]
−
[[Category:Leukemia regimens]]
 
−
[[Category:Plasma cell dyscrasia regimens]]
 

Latest revision as of 01:07, 18 May 2024

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Section editor
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 Samuel M. Rubinstein, MD
University of North Carolina
Chapel Hill, NC, USA
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4 regimens on this page
4 variants on this page


Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

EMN

IMWG

First-line therapy

PAD/VCD

PAD/VCD: PS-341 (Bortezomib), Adriamycin liposomal (Pegylated liposomal doxorubicin), Dexamethasone alternating with Velcade (Bortezomib), Cyclophosphamide, Dexamethasone

Regimen

Study Dates of enrollment Evidence
Royer et al. 2016 2010-04 to 2013-07 Phase 2

Targeted therapy, both portions (cycles 1 to 4)

Chemotherapy, PAD portion (cycles 1 & 3)

Chemotherapy, VCD portion (cycles 2 & 4)

Glucocorticoid therapy, both portions (cycles 1 to 4)

21-day cycle for 4 cycles

Subsequent treatment

References

  1. Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP; IFM. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol. 2016 Jun 20;34(18):2125-32. Epub 2016 Apr 25. link to original article contains dosing details in manuscript PubMed EudraCT 2009-016607-33

Lenalidomide & Dexamethasone (Rd)

Rd: Revlimid (Lenalidomide) & low-dose dexamethasone
RevDex: Revlimid (Lenalidomide) & Dexamethasone
Ld: Lenalidomide & low-dose dexamethasone
LenDex: Lenalidomide & Dexamethasone

Regimen

Study Dates of enrollment Evidence
Musto et al. 2013 2009-03-01 to 2011-05-31 Phase 2

Targeted therapy

Glucocorticoid therapy

28-day cycle for 4 cycles

Subsequent treatment

  • Musto et al. 2013, responding patients eligible for transplant: HSCT consolidation per center protocol
  • Musto et al. 2013, responding patients ineligible for transplant: Rd consolidation x 4 (8 cycles total), then lenalidomide maintenance

References

  1. Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia. 2014 Jan;28(1):222-5. Epub 2013 Aug 20. link to original article contains dosing details in manuscript PubMed

Consolidation after first-line therapy

Melphalan monotherapy, then auto HSCT

Regimen

Study Dates of enrollment Evidence
Royer et al. 2016 2010-04 to 2013-07 Phase 2

Preceding treatment

Chemotherapy

  • Melphalan (Alkeran) IV once (day not specified) by the following age- and renal function-based criteria:
    • 65 years old or younger AND CrCl 30 mL/min/1.73m2 or more: 200 mg/m2
    • Older than 65 years old OR CrCl less than 30 mL/min/1.73m2: 140 mg/m2

1 or 2 courses

References

  1. Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol. 2016 Jun 20;34(18):2125-32. Epub 2016 Apr 25. link to original article contains dosing details in abstract PubMed EudraCT 2009-016607-33

Maintenance after first-line therapy

Lenalidomide monotherapy

Regimen

Study Dates of enrollment Evidence
Musto et al. 2013 2009-03-01 to 2011-05-31 Phase 2

Preceding treatment

  • Upfront Rd x 8

Targeted therapy

28-day cycles

References

  1. Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia. 2014 Jan;28(1):222-5. Epub 2013 Aug 20. link to original article contains dosing details in manuscript PubMed
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