Contributions
Abstract: PB1962
Type: Publication Only
Background
Lenalidomide is a well-established and effective treatment for haematological malignancies particularly multiple myeloma (MM), but also lymphoma and myelodysplastic syndromes. It can be used as both a single agent and in combination with dexamethasone or other chemotherapeutic agents. A previous study in myeloma patients demonstrated an increased incidence of second primary malignancy (SPM) in patients treated with lenalidomide and dexamethasone (7% - 8%) compared to those treated with dexamethasone and placebo (2%>3%) [1 - 3].
Aims
We reviewed all patients treated with Lenalidomide in a single centre from January 2008 to May 2016 to establish the real-world of SPM.
Methods
A database of patients (n=137) treated with lenalidomide in the specified timeframe was created from pharmacy records. A search of the hospital’s patient management system was performed to identify: (1) type and date of primary haematological diagnosis, and (2) type and date of second malignancy based on histology. An analysis of the data was performed to establish: (1) incidence of SPM, (2) latency between primary haematological malignancy and SPM, (3) latency between starting lenalidomide and SPM, (4) types and subtypes of SPM.
Results
The majority of patients were treated for Multiple Myeloma (67%). Other primary haematological diagnoses included myelodysplastic syndrome(MDS), Non-Hodgkin lmphoma(NHL), and Idiopathic myelofibrosis(IMF). The incidence of SPM post-treatment with lenalidomide was 12 patients (8%). 9 patients had a diagnosis of second malignancy prior to starting lenalidomide treatment. The median latency between starting lenalidomide and SPM diagnosis was 24 months.. The median latency between primary haematological diagnosis and SPM diagnosis was 37 months. The most common types of SPMs were haematological; 7 (64%), patients had t-MDS 3 (27%), 3 Acute Myeloid Leukemia(AML) (27%), and 1 patient developed B-cell Lymphoma (9%). Next most common was skin malignancy; 3 (27%), all squamous cell carcinoma (SCC). One patient developed prostate carcinoma (9%).
Conclusion
Studies show the estimated incidence of SPM in MM to lie between 2%>10% over a 25 year period [5]. This study demonstrates a higher incidence (12%), however it includes patients treated for other primary haematological malignancies. This data demonstrates a similar incidence of SPM to previous studies (8%) post-treatment with lenalidomide [1 - 3]. Haematological malignancy was the commonest SPM however this differs from other studies which showed a majority of solid tumors (including skin malignancy) [4]. We found t-MDS/AML and skin malignancy to be the most significant SPMs. This is in agreement with some published reports [4, 5]. No analysis was made of patient specific risks or disease specific risks. This data supports the conclusion that the risk of SPM must be considered before commencing a patient on lenalidomide therapy.
- McCarthy PL, Owzar K, Hofmeister CC, et al. Lenalidomide after stem-cell transplantation for multiple myeloma. N Engl J Med. 2012;366(19):1770-1781.
- Palumbo A, Hajek R, Delforge M, et al. Continuous lenalidomide treatment for newly diagnosed multiple myeloma. N Engl J Med. 2012;366(19):1759-1769.
- Attal M, Lauwers-Cances V, Marit G, et al. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N Engl J Med. 2012;366(19):1782-1791.
- Dimopoulos M.A, Richardson P.G, et al. A review of second primary malignancy in patients with relapsed or refactory multiple myeloma treated with lenalidamide. Blood 2012;119:(12)2764 – 2767.
- Engelhardt M, Ihorst G, et al. Large registry analysis to accurately define second malignancy rates and risks in a well-characterized cohort of 744 consecutive multiple myeloma patients followed-up for 25 years. Haematologica. 2015;100:(10)1340 – 1349.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Multiple Myeloma, MDS, lymphoma, Second malignancy
Abstract: PB1962
Type: Publication Only
Background
Lenalidomide is a well-established and effective treatment for haematological malignancies particularly multiple myeloma (MM), but also lymphoma and myelodysplastic syndromes. It can be used as both a single agent and in combination with dexamethasone or other chemotherapeutic agents. A previous study in myeloma patients demonstrated an increased incidence of second primary malignancy (SPM) in patients treated with lenalidomide and dexamethasone (7% - 8%) compared to those treated with dexamethasone and placebo (2%>3%) [1 - 3].
Aims
We reviewed all patients treated with Lenalidomide in a single centre from January 2008 to May 2016 to establish the real-world of SPM.
Methods
A database of patients (n=137) treated with lenalidomide in the specified timeframe was created from pharmacy records. A search of the hospital’s patient management system was performed to identify: (1) type and date of primary haematological diagnosis, and (2) type and date of second malignancy based on histology. An analysis of the data was performed to establish: (1) incidence of SPM, (2) latency between primary haematological malignancy and SPM, (3) latency between starting lenalidomide and SPM, (4) types and subtypes of SPM.
Results
The majority of patients were treated for Multiple Myeloma (67%). Other primary haematological diagnoses included myelodysplastic syndrome(MDS), Non-Hodgkin lmphoma(NHL), and Idiopathic myelofibrosis(IMF). The incidence of SPM post-treatment with lenalidomide was 12 patients (8%). 9 patients had a diagnosis of second malignancy prior to starting lenalidomide treatment. The median latency between starting lenalidomide and SPM diagnosis was 24 months.. The median latency between primary haematological diagnosis and SPM diagnosis was 37 months. The most common types of SPMs were haematological; 7 (64%), patients had t-MDS 3 (27%), 3 Acute Myeloid Leukemia(AML) (27%), and 1 patient developed B-cell Lymphoma (9%). Next most common was skin malignancy; 3 (27%), all squamous cell carcinoma (SCC). One patient developed prostate carcinoma (9%).
Conclusion
Studies show the estimated incidence of SPM in MM to lie between 2%>10% over a 25 year period [5]. This study demonstrates a higher incidence (12%), however it includes patients treated for other primary haematological malignancies. This data demonstrates a similar incidence of SPM to previous studies (8%) post-treatment with lenalidomide [1 - 3]. Haematological malignancy was the commonest SPM however this differs from other studies which showed a majority of solid tumors (including skin malignancy) [4]. We found t-MDS/AML and skin malignancy to be the most significant SPMs. This is in agreement with some published reports [4, 5]. No analysis was made of patient specific risks or disease specific risks. This data supports the conclusion that the risk of SPM must be considered before commencing a patient on lenalidomide therapy.
- McCarthy PL, Owzar K, Hofmeister CC, et al. Lenalidomide after stem-cell transplantation for multiple myeloma. N Engl J Med. 2012;366(19):1770-1781.
- Palumbo A, Hajek R, Delforge M, et al. Continuous lenalidomide treatment for newly diagnosed multiple myeloma. N Engl J Med. 2012;366(19):1759-1769.
- Attal M, Lauwers-Cances V, Marit G, et al. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N Engl J Med. 2012;366(19):1782-1791.
- Dimopoulos M.A, Richardson P.G, et al. A review of second primary malignancy in patients with relapsed or refactory multiple myeloma treated with lenalidamide. Blood 2012;119:(12)2764 – 2767.
- Engelhardt M, Ihorst G, et al. Large registry analysis to accurately define second malignancy rates and risks in a well-characterized cohort of 744 consecutive multiple myeloma patients followed-up for 25 years. Haematologica. 2015;100:(10)1340 – 1349.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Multiple Myeloma, MDS, lymphoma, Second malignancy