Single-agent lenalidomide induces complete remission of acute myeloid leukemia in patients with isolated trisomy 13

Abstract

Patients with acute myeloid leukemia (AML) frequently fail chemotherapy due to refractory disease, relapse, or toxicity. Among older AML patients (age > 60 years), there are few long-term survivors. Lenalidomide is a candidate for study in AML based on its clinical activity in a related disorder, myelodysplastic syndrome (MDS), with the 5q- chromosomal abnormality. We report induction of sustained morphologic and cytogenetic complete remission in 2 older AML patients treated with high-dose, single-agent lenalidomide; each patient had trisomy 13 as the sole cytogenetic abnormality. We show for the first time that lenalidomide has clinical activity in this poor-risk cytogenetic subset of AML. The clinical trials described in this paper have been registered with www.clinicaltrials.gov under identifiers NCT00466895 and NCT00546897.

Figures

Figure 1

Bone marrow morphology and karyotype of case 1 at AML diagnosis. (A) Bone marrow aspirate blast morphology (left, Wright-Giemsa, ×100) and biopsy (right, Leder stain, ×100) demonstrating AML at diagnosis (stains were obtained from Richard-Allan Scientific, Kalamazoo, MI). The blast cells are medium-sized and have a high nuclear:cytoplasmic ratio, agranular Leder-negative cytoplasm, and visible nucleoli. Slides were viewed with an Olympus BX41 microscope (Olympus, Tokyo, Japan) at a 100×/1.30 NA oil objective with Resolve high-viscosity microscope immersion oil (Richard-Allan Scientific). Images were acquired using an Olympus DP70 camera and were processed with DP Controller 1.2.1.108 software (Olympus). Individual image files were assembled in Microsoft PowerPoint 2007. (B) AML karyotype showing trisomy 13 (arrow) at time of AML diagnosis (47,XY, + 13[5]/46,XY[15]).