Lenalidomide as a Potent Inducer of Graft Versus Leukemia Effect in Patients with Hematologic Malignancies at High Risk of Relapse Post Allogeneic Stem Cell Transplant

Excerpt

There are limited treatment options for post allogeneic stem cell transplant (ASCT) relapse of hematological malignancies. Options include donor lymphocyte infusion (DLI), chemotherapy, second transplant, targeted therapies or combinations of these. DLI alone may not help due to time it takes for its graft versus leukemia (GVL) effects; it is effective only in about one-third patients [1]. Agents like nivolumab have been shown to induce GVL post ASCT without DLI [2, 3]. However, nivolumab is prohibitively expensive in India. Lenalidomide is an immunomodulator that induces effector T cells and has both anti-leukemia and lymphoma activity. It carries the advantage of being an oral drug and is inexpensive. We report outcomes of 3 patients with impending relapse post ASCT in whom lenalidomide was used for its immunomodulatory effects since no other treatment options were feasible. …