Pomalidomide is active in the treatment of anemia associated with myelofibrosis

Ayalew Tefferi*, Srdan Verstovsek, Giovanni Barosi, Francesco Passamonti, Gail J. Roboz, Heinz Gisslinger, Ronald L. Paquette, Francisco Cervantes, Candido E. Rivera, H. Joachim Deeg, Juergen Thiele, Hans M. Kvasnicka, James W. Vardiman, Yanming Zhang, B. Nebiyou Bekele, Ruben A. Mesa, Robert P. Gale, Hagop M. Kantarjian

*Corresponding author for this work

Research output: Contribution to journalArticle

173 Scopus citations

Abstract

Purpose: Thalidomide and lenalidomide can alleviate anemia in myelofibrosis. However, their value is undermined by their respective potential to cause peripheral neuropathy and myelosuppression. We therefore evaluated the safety and therapeutic activity of another immunomodulatory drug, pomalidomide. Methods: In a phase II randomized, multicenter, double-blind, adaptive design study, four treatment arms were evaluated: pomalidomide (2 mg/d) plus placebo, pomalidomide (2 mg/d) plus prednisone, pomalidomide (0.5 mg/d) plus prednisone, and prednisone plus placebo. Pomalidomide was administered for up to 12 28-day treatment cycles. Prednisone (30 mg/d) was given in a tapering dose schedule during the first three cycles. Response was assessed by International Working Group criteria. Results: Eighty-four patients with myelofibrosis-associated anemia were randomly assigned to the aforementioned treatment arms: 22, 19, 22, and 21, respectively. Response in anemia was documented in 20 patients, including 15 who became transfusion independent. Response rates in the four treatment arms were 23% (95% CI, 5% to 41%), 16% (95% CI, 0% to 33%), 36% (95% CI, 16% to 56%), and 19% (95% CI, 2% to 36%). The corresponding figures for patients receiving ≥ 3 cycles of treatment (n = 62) were 38%, 23%, 40%, and 25%. Response to pomalidomide with or without prednisone was durable (range, 3.2 to 16.9+ months) and significantly better in the absence of leukocytosis (37% v 8%; P = .01); JAK2V617F or cytogenetic status did not affect response. Grade ≥ 3 toxicities were infrequent and included (in each treatment arm) neutropenia (9%; 16%; 5%; 5%), thrombocytopenia (14%; 16%; 9%; 5%), and thrombosis (9%; 5%; 0%; 0%). Conclusion: Pomalidomide therapy at 0.5 or 2 mg/d with or without an abbreviated course of prednisone is well tolerated in patients with myelofibrosis and active in the treatment of anemia.

Original languageEnglish (US)
Pages (from-to)4563-4569
Number of pages7
JournalJournal of Clinical Oncology
Volume27
Issue number27
DOIs
StatePublished - Sep 20 2009

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Tefferi, A., Verstovsek, S., Barosi, G., Passamonti, F., Roboz, G. J., Gisslinger, H., Paquette, R. L., Cervantes, F., Rivera, C. E., Deeg, H. J., Thiele, J., Kvasnicka, H. M., Vardiman, J. W., Zhang, Y., Bekele, B. N., Mesa, R. A., Gale, R. P., & Kantarjian, H. M. (2009). Pomalidomide is active in the treatment of anemia associated with myelofibrosis. Journal of Clinical Oncology, 27(27), 4563-4569. https://doi.org/10.1200/JCO.2008.21.7356