Longitudinal bone marrow evaluations for myelodysplasia in patients with myeloma before and after treatment with lenalidomide

Abstract

Lenalidomide (LEN) treatment in multiple myeloma (MM) results in a superior outcome. However, there is concern for increased myelodysplastic syndrome/acute myeloid leukemia (MDS/AML) associated with LEN. Thus, bone marrow morphology and cytogenetics studies from 40 patients were evaluated for early signs of MDS prior to therapy, during therapy and at follow-up. Newly diagnosed patients with MM treated with LEN and dexamethasone (LD) alone or followed by autologous stem cell transplant (LD/ASCT), or patients with relapsed/refractory MM treated with LEN, bendamustine and dexamethasone (BLD) were included. One patient developed MDS. Baseline prevalence of mild morphologic myelodysplasia was highest in pretreated patients with MM (BLD, 71%), but was also seen in newly diagnosed patients (LD and LD/ASCT, 17%). The prevalence of myelodysplasia did not increase over time. Thus, this study did not reveal rapidly emerging MDS in 39 of 40 patients with MM treated with LEN. The development of MDS in one patient suggests that longer follow-up is needed for all.

Keywords::

• Myeloma
• lenalidomide
• myelodysplastic syndrome

Acknowledgements

The authors are grateful to Mr. Dale Lewis for outstanding technical assistance with the molecular cytogenetics assays, carried out in the University of Pittsburgh Cell Culture and Cytogenetics Facility.

Potential conflict of interest:

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.

This work was supported, in part, by the Multiple Myeloma Research Foundation, the Leukemia & Lymphoma Society, the Pennsylvania Department of Health and the National Cancer Institute (P30CA047904).