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The article discusses the use of ruxolitinib after fedratinib failure in patients with myelofibrosis. It presents a case series of 14 patients who received ruxolitinib after fedratinib therapy, detailing their clinical outcomes and responses. The study highlights the potential clinical benefit of second-line ruxolitinib, achieving spleen and symptoms response in a subset of patients. The findings suggest that sequential use of ruxolitinib after fedratinib may be beneficial for selected patients, with no observed excess toxicity in the second-line setting. [Extracted from the article]

The article presents the first prospective study of initial treatment in primary plasma cell leukemia (PPCL) based on a combination of lenalidomide and low-dose dexamethasone (Ld). It notes the capability of Ld to ameliorate overall response rate (ORR) and at least very good partial response (VGPR) rate when compared with any other reported treatment conducted without novel drugs. It also reveals that PPCL patients have more compromised marrow and renal function than multiple myeloma patients.

This multicenter phase II trial evaluated the safety and efficacy of lenalidomide−prednisone (RP) induction, followed by lenalidomide−melphalan−prednisone (MPR) consolidation and RP maintenance in elderly unfit newly diagnosed myeloma patients. Patients received four 28-day RP induction courses (lenalidomide 25 mg/day on days 1-21 and prednisone 50 mg three times/week), followed by six 28-day MPR consolidation cycles (melphalan 2 mg, prednisone 50 mg three times/week and lenalidomide 10-15 mg/day on days 1-21), and maintenance with lenalidomide (10 mg/day on days 1-21 every 28 days) plus prednisone (25 mg three times/week). Forty-six patients were enrolled. Median age was 75 years, 59% of patients had at least one comorbidity and 35% at least two. Partial response rate was 80%, including 29% very good partial response. Median time to progression was 19.6 months, median progression-free survival was 18.4 months and 2-year overall survival was 80%. At the tolerated consolidation dose (melphalan 25 mg/month and lenalidomide 10 mg/day), the most frequent grade 3 adverse events were neutropenia (36.4%), anemia (12.1%), cutaneous reactions (18.2%) and infections (12.1%). Grade 4 neutropenia occurred in 12.1% of patients. In conclusion, RP induction followed by MPR consolidation and RP maintenance showed a manageable safety profile, and reduced the risk of severe hematological toxicity in unfit elderly myeloma patients. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Lenalidomide is a thalidomide analogue, designed to have improved efficacy and tolerability over the parent drug. The aim of this retrospective analysis is to evaluate the impact of thalidomide therapy on lenalidomide response and outcome in relapse or refractory multiple myeloma patients. Patients and methods: A total of 106 relapsed or refractory multiple myeloma patients received lenalidomide 25mg plus dexamethasone as salvage therapy; 80 patients progressed on thalidomide treatment (thalidomide-resistant) and 26 patients discontinued thalidomide in at least partial remission (thalidomide-sensitive). Median time from diagnosis to lenalidomide treatment was 57months. Median prior lines of therapies were 3, range 1–6. 62% of patients were previously treated with autologous stem cell transplantation, and 71% with bortezomib-based regimens. Results: In the thalidomide-resistant and -sensitive groups, the at least partial response rates were 56.2% and 61.5% (P =.45), including at least VGPR rates of 16.2% and 11.5%; the median progression free survival was 10 and 12months (P =.12) and the median overall survival was 17 and 18.5months (P =.50), respectively. Conclusion: Lenalidomide may be equally effective in heavily pre-treated multiple myeloma patients who are thalidomide-resistant or thalidomide-sensitive to a previous therapy. [Copyright &y& Elsevier]