A phase II trial of cyclophosphamide, lenalidomide and dexamethasone in previously treated patients with AL amyloidosis

Immune-modulatory drugs are active in immunoglobulin light-chain amyloidosis and the addition of alkylating agents can potentiate their action. In this phase II prospective trial we treated with cyclophosphamide, lenalidomide and dexamethasone 21 patients who were refractory (13, 62%) or relapsed (8, 38%) after prior treatment including melphalan in all cases, bortezomib in 4 and thalidomide in 6. The median number of cycles administered was 4 (range: 2-9 cycles). Severe adverse events were observed in 57% of patients, most common being neutropenia (29%). The hematologic response rate was 62%, with 1 complete response and 5 very good partial responses. Overall median survival was 3 years. The achievement of CR/VGPR was associated with a significant survival advantage. The combination of cyclophosphamide, lenalidomide and dexamethasone is an effective treatment for relapsed/refractory AL amyloidosis, and good quality hematologic response should be the aim of treatment in this setting. (clinicaltrials.gov identifier: NCT00607581).