Phase 1 study of pomalidomide and dexamethasone for relapsed/refractory primary CNS or vitreoretinal lymphoma

Han W. Tun, Patrick B. Johnston, Lisa M. DeAngelis, Pamela J. Atherton, Levi D. Pederson, Patricia A. Koenig, Craig B. Reeder, Antonio M. Padula Omuro, David Schiff, Brian O'Neill, Jose Pulido, Kurt A. Jaeckle, Christian Grommes, Thomas E. Witzig

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

The combination of pomalidomide (POM) and dexamethasone (DEX) was evaluated for relapsed/refractory primary central nervous system lymphoma (PCNSL) and primary vitreoretinal lymphoma (PVRL) to determine the maximal tolerated dose (MTD) ofPOMas the primary objective, and overall response rate (ORR), progression-free survival (PFS), and safety profile as secondary objectives. A cohorts-of-3 study design was used with a doseescalation schedule consisting of POM (3, 5, 7, or 10 mg) orally daily for 21 days every 28 days and DEX 40 mg orally every week. After 2 cycles, POM was continued alone until disease progression, intolerance, or subject withdrawal. Following MTD determination, the MTD cohort was expanded. Twenty-five of 29 patients with the median of 3 prior treatments were eligible for assessment as per international PCNSL collaborative group criteria. The MTD of POM was 5 mg daily for 21 days every 28 days. Whole-study ORR was 48% (12 of 25; 95% confidence interval [CI], 27.8%, 68.7%) with 6 complete response (CR), 2 complete response, unconfirmed (CRu), and 4 partial response (PR). MTD cohort ORR was 50% (8 of 16; 95% CI, 24.7%, 75.4%) with 5 CR, 1 CRu, and 2 PR. Median PFS was 5.3 months (whole study) and 9 months (for responders). One patient had pseudoprogression. Grade 3/4 hematologic toxicities included neutropenia (21%), anemia (8%), and thrombocytopenia (8%). Grade 3/4 nonhematologic toxicities included lung infection (12%), sepsis (4%), fatigue (8%), syncope (4%), dyspnea (4%), hypoxia (4%), respiratory failure (8%), and rash (4%). POM/DEX treatment is feasible with significant therapeutic activity against relapsed/refractory PCNSL and PVRL.

Original languageEnglish (US)
Pages (from-to)2240-2248
Number of pages9
JournalBlood
Volume132
Issue number21
DOIs
StatePublished - Nov 22 2018

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Tun, H. W., Johnston, P. B., DeAngelis, L. M., Atherton, P. J., Pederson, L. D., Koenig, P. A., Reeder, C. B., Padula Omuro, A. M., Schiff, D., O'Neill, B., Pulido, J., Jaeckle, K. A., Grommes, C., & Witzig, T. E. (2018). Phase 1 study of pomalidomide and dexamethasone for relapsed/refractory primary CNS or vitreoretinal lymphoma. Blood, 132(21), 2240-2248. https://doi.org/10.1182/blood-2018-02-835496