Plasma cell leukemia

From HemOnc.org - A Hematology Oncology Wiki
Jump to navigation Jump to search

Section editor
Headshot Cowan.jpg
Andrew J. Cowan, MD
University of Washington
Seattle, WA, USA

LinkedIn
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 Evidence
Royer et al. 2016 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

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 Evidence
Musto et al. 2013 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