Melphalan, Lenalidomide, and Dexamethasone in Treating Patients With Primary Systemic Amyloidosis

OBJECTIVES:

Primary

• To determine the tolerability and safety of melphalan, lenalidomide, and dexamethasone, in terms of toxicity, in patients with primary systemic amyloidosis.
• To determine the hematologic response rate in patients treated with this regimen.

Secondary

• To assess organ response in patients treated with this regimen.

OUTLINE: Patients receive oral lenalidomide once daily on days 1-21, oral melphalan once daily on days 1-4, and oral dexamethasone once on days 1, 8, 15, and 22. Treatment repeats every 28 days for up to 12 months in the absence of disease progression or unacceptable toxicity.

After completion of study therapy, patients are followed every 3 months until disease progression and then annually thereafter.

Inclusion criteria

DISEASE CHARACTERISTICS:

• Diagnosis of primary systemic amyloidosis

PATIENT CHARACTERISTICS:

• Not pregnant
• Negative pregnancy test
• Able to tolerate an anticoagulation regimen (e.g., 325 mg of aspirin per day, therapeutic warfarin, or low molecular weight heparin)

PRIOR CONCURRENT THERAPY:

• Recovered from prior therapy

• Permanent or stable side effects/changes allowed
• Prior chemotherapy, thalidomide, lenalidomide, or steroids for amyloidosis allowed
• More than 4 weeks since prior and no other concurrent cytotoxic chemotherapy or radiotherapy

Exclusion criteria

• No secondary or familial amyloidosis
• No multiple myeloma (≥ 30% plasma cells in bone marrow biopsy or lytic bone lesions)
• No prior cumulative doses of oral melphalan > 200 mg
• No more than one prior course of high-dose melphalan with stem cell transplant