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Lenalidomide for Myelodysplastic Syndrome Refractory to Hypomethylating Agents

This study has been completed.
Information provided by (Responsible Party):
Washington University School of Medicine Identifier:
First received: November 15, 2010
Last updated: November 30, 2015
Last verified: November 2015
The purpose of this study is to determine the proportion of confirmed responses (complete response, partial response, and hematologic improvement as defined by revised IWG criteria during the 12 months of treatment.

Condition Intervention Phase
Myelodysplastic Syndromes Drug: Lenalidomide Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase II Trial of High Dose Lenalidomide in Patients With Myelodysplastic Syndrome Refractory to Hypomethylating Agents

Resource links provided by NLM:

Further study details as provided by Washington University School of Medicine:

Primary Outcome Measures:
  • Number of Participants With Confirmed Responses (Complete Remission, Partial Remission, or Hematologic Improvement) as Defined by the International Working Group Criteria [ Time Frame: Up to 56 weeks (14 cycles of treatment) ]
    • Complete remission (CR): ≤5% myeloblasts bone marrow blasts, normal maturation in all cell lines (dysplasia will be noted), ≥11 g/dl peripheral blood hemoglobin, ≥100x10^9cells/μL peripheral blood platelets, ≥1000 cells/ μL peripheral blood absolute neutrophil count (ANC), and 0% peripheral blood blasts.
    • Marrow complete remission (MCR): ≤5% myeloblasts and decreased by ≥50% compared to pre-treatment bone marrow blasts, bone marrow morphology not relevant, and peripheral blood (if hematological improvement they will be noted in addition to marrow CR).
    • Partial remission (PR): previously had ≥5% myeloblasts and now have ≥5% myeloblasts but decreased by ≥50% compared to pre-treatment, bone marrow morphology not relevant, ≥11 g/dl peripheral blood hemoglobin, ≥100x109cells/μL peripheral blood platelets, ≥1000 cells/ μL peripheral blood ANC, and 0% peripheral blood blasts

Secondary Outcome Measures:
  • Overall Survival Rate [ Time Frame: 6 months after end of treatment (up to 82 weeks from start of treatment) ]
    -Overall survival rate is the percentage of participants who were alive 6 months after end of treatment.

  • Duration of Response [ Time Frame: Until 6 months after end of treatment ]
  • Time to Discontinuation of Treatment [ Time Frame: Up to 56 weeks (14 cycles) ]
  • Toxicity as Measured by Number of Participants Who Experienced Related Grade 3-5 Adverse Events Based on CTCAE Version 4 [ Time Frame: 30 days after end of treatment (up to 60 weeks) ]
  • Time to Progression [ Time Frame: Up to 6 months after completion of treatment (up to 82 weeks from start of treatment) ]
    The time to progression is defined as the time from registration to the date of progression or last follow-up. Those who die will be considered to have had disease progression unless documented evidence clearly indicates no progression has occurred.

Enrollment: 24
Study Start Date: June 2011
Study Completion Date: August 2015
Primary Completion Date: May 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Lenalidomide

Lenalidomide 50 mg/day for two 28 day cycles.

Patients who have bone marrow aplasia as defined by a cellularity of <10% will be observed till counts recover. If patients do not progress following 2 cycles of HD lenalidomide, they will receive low dose lenalidomide 10 mg daily for 12 cycles.

Drug: Lenalidomide
Other Name: Revlimid


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patient must be able to understand and voluntarily sign an informed consent form.
  • Patient must be ≥ 18 years old.
  • Patient must be able to adhere to the study visit schedule and other protocol requirements.
  • Patient must have histologically confirmed Myelodysplastic Syndrome as defined by FAB Classification including CMML and secondary MDS which has either:

    • progressed at any time during treatment with hypomethylating agents
    • failed to achieve a response after 6 cycles
    • progressed after treatment with hypomethylating agents had been discontinued Criteria for response and for progression as defined by revised IWG criteria
  • Patient must have discontinued all previous cancer therapy, including radiation, hormonal therapy and surgery at least 4 weeks prior to treatment in this study.
  • Patient must have an ECOG performance status of ≤ 2 at study entry
  • Patient must have laboratory test results within these ranges:

    • calculated creatinine clearance ≥ 30ml/min by Cockcroft-Gault formula
    • total bilirubin ≤ 1.5 x ULN
    • AST (SGOT) and ALT (SGPT) ≤ 3 x ULN
  • Patient must be disease free of prior malignancies for at least 5 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or breast.
  • Patient must be registered into the mandatory Revlimid REMS® program and be willing and able to comply with the requirements of Revlimid REMS®.
  • If a female of childbearing potential (FCBP), patient must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 to 14 days prior to initiation of therapy and again within 24 hours prior to prescribing lenalidomide for Cycle 1 (prescriptions must be filled within 7 days).

Females of reproductive potential must adhere to the scheduled pregnancy testing as required in the Revlimid REMS® program. A FCBP is defined as a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months).

-If a FCBP, patient must agree to use two reliable forms of contraception simultaneously or to practice complete abstinence from heterosexual intercourse during the following time periods related to this study: 1) for at least 28 days before starting study drug; 2) while participating in the study; and 3) for at least 28 days after discontinuation from the study. The two methods of reliable contraception must include one highly effective method (i.e. intrauterine device (IUD), hormonal [birth control pills, injections, or implants], tubal ligation, partner's vasectomy) and one additional effective (barrier) method (i.e. latex condom, diaphragm, cervical cap). FCBP must be referred to a qualified provider of contraceptive methods if needed

Exclusion Criteria:

  • Patient must not have any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
  • Patient must not be pregnant or breastfeeding.
  • Patient must not have any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.
  • Patient must not use any other experimental drug or therapy within 28 days of baseline.
  • Patient must not have a known hypersensitivity to thalidomide.
  • Patient must not have developed of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs.
  • Patient must not have any prior use of lenalidomide.
  • Patient must not be concurrently using other anti-cancer agents or treatments.
  • Patient must not have known seropositivity for or active viral infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Patients who are seropositive because of hepatitis B virus vaccine are eligible.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01246076

United States, Arizona
Mayo Clinic Scottsdale AZ
Scottsdale, Arizona, United States
United States, Missouri
Washington University School of Medicine
St. Louis, Missouri, United States, 63110
Sponsors and Collaborators
Washington University School of Medicine
Principal Investigator: Ravi Vij, M.D. Washington University School of Medicine
  More Information

Additional Information:
Responsible Party: Washington University School of Medicine Identifier: NCT01246076     History of Changes
Other Study ID Numbers: 201011810
Study First Received: November 15, 2010
Results First Received: August 26, 2015
Last Updated: November 30, 2015

Additional relevant MeSH terms:
Myelodysplastic Syndromes
Pathologic Processes
Bone Marrow Diseases
Hematologic Diseases
Precancerous Conditions
Immunologic Factors
Physiological Effects of Drugs
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors
Antineoplastic Agents
Immunosuppressive Agents
Leprostatic Agents
Anti-Bacterial Agents
Anti-Infective Agents processed this record on September 19, 2017