Use of ixazomib, lenalidomide and dexamethasone in patients with relapsed amyloid light-chain amyloidosis

With improving outcomes in amyloid light-chain (AL) amyloidosis, there is a need to study novel agents in this setting. We report outcomes of 40 patients with relapsed AL amyloidosis treated with ixazomib + lenalidomide + dexamethasone (IRd). Haematological responses were assessed on an intention-to-treat basis at three months: complete response (CR) - 8 (20 center dot 5%), very good partial response (VGPR) - 8 (20 center dot 5%), partial response (PR) - 7 (17 center dot 9%) and no response (NR) - 16 (41 center dot 0%). One patient had missing data. Six patients subsequently improved response. Best responses were: CR - 10 (25 center dot 6%), VGPR - 8 (20 center dot 5%), PR - 7 (17 center dot 9%), NR - 14 (35 center dot 9%). Cardiac and renal organ responses occurred in 5 center dot 6% and 13 center dot 3% respectively. Median progession-free survival (PFS) was 17 center dot 0 months (95% CI 7 center dot 3-20 center dot 7 months), improving to 28 center dot 8 months (95% CI 20 center dot 6-37 center dot 0 months) in those achieving CR/VGPR. Median overall survival was 29 center dot 1 months (95% CI 24-33 months). Serious adverse events were seen in 14 (35 center dot 0%) patients inclusive of 15 admissions due to: infection (6/15, 40 center dot 0%), fluid overload (5/15, 33 center dot 3%), cardiac arrhythmia (2/15, 13 center dot 3%), renal dysfunction (1/15, 6 center dot 6%) and anaemia (1/15, 6 center dot 6%). In summary, IRd is an oral treatment option with a manageable toxicity profile leading to deep responses in 47% of patients with relapsed AL amyloidosis.