{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:14:38Z","timestamp":1790727278242,"version":"4.1.0"},"reference-count":41,"publisher":"American Society of Hematology","issue":"13","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,7,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Lenalidomide is an effective component of induction and maintenance therapy for multiple myeloma, though with a risk of secondary malignancies, including acute lymphoblastic leukemia (ALL). In contrast to therapy-related myeloid neoplasia, lenalidomide-associated lymphoblastic neoplasia remains poorly characterized. We conducted a dual institution retrospective study of 32 ALL cases that arose after lenalidomide maintenance (all B-lineage, 31\/32 BCR::ABL-negative). B-cell ALL (B-ALL) was diagnosed at median 54\u00a0months (range, 5-119) after first exposure to lenalidomide and after median 42\u00a0months of cumulative lenalidomide exposure (range, 2-114). High incidence of TP53 mutations (9\/19 evaluable cases) and low hypodiploidy (8\/26 patients) were identified. Despite median age of 65 years and poor-risk B-ALL features observed in the cohort, rates of complete response (CR) or CR with incomplete hematologic recovery were high (25\/28 patients receiving treatment). Median event-free survival was 35.4\u00a0months among treated patients (not reached among those undergoing allogeneic hematopoietic cell transplantation [HCT]). Sixteen patients remain alive without evidence of B-ALL after HCT or extended maintenance therapy. We also describe regression of B-ALL or immature B-cell populations with B-ALL immunophenotype after lenalidomide discontinuation in 5 patients, suggesting lenalidomide may drive leukemic progression even after initiation of lymphoblastic neoplasia and that lenalidomide withdrawal alone may be an appropriate first-line intervention in selected patients. Monitoring for early B-ALL\u2013like proliferations may offer opportunities for lenalidomide withdrawal to prevent progression. Established combination chemotherapy regimens, newer surface antigen-targeted approaches, and allogeneic HCT are effective in many patients with lenalidomide-associated B-ALL and should be offered to medically fit patients.<\/jats:p>","DOI":"10.1182\/bloodadvances.2022009212","type":"journal-article","created":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T17:07:00Z","timestamp":1677258420000},"page":"3087-3098","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":29,"title":["Lenalidomide-associated B-cell ALL: clinical and pathologic correlates and sensitivity to lenalidomide withdrawal"],"prefix":"10.1182","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5248-9117","authenticated-orcid":false,"given":"Mark B.","family":"Geyer","sequence":"first","affiliation":[{"name":"1Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"},{"name":"2Cell Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian C.","family":"Shaffer","sequence":"additional","affiliation":[{"name":"3Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavana","family":"Bhatnagar","sequence":"additional","affiliation":[{"name":"4Section of Hematology\/Oncology, Department of Medicine, West Virginia University, West Virginia University Cancer Institute, Morgantown, WV"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8971-2199","authenticated-orcid":false,"given":"Alice S.","family":"Mims","sequence":"additional","affiliation":[{"name":"5Acute Leukemia Program, The Ohio State University, The James Cancer Hospital and Solove Research Institute, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Klein","sequence":"additional","affiliation":[{"name":"5Acute Leukemia Program, The Ohio State University, The James Cancer Hospital and Solove Research Institute, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4961-1481","authenticated-orcid":false,"given":"Deepika","family":"Dilip","sequence":"additional","affiliation":[{"name":"6Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0363-7763","authenticated-orcid":false,"given":"Jacob L.","family":"Glass","sequence":"additional","affiliation":[{"name":"1Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard","family":"Lozanski","sequence":"additional","affiliation":[{"name":"7Department of Pathology, The Ohio State University, The James Cancer Hospital and Solove Research Institute, Columbus, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani","family":"Hassoun","sequence":"additional","affiliation":[{"name":"8Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3152-1189","authenticated-orcid":false,"given":"Heather","family":"Landau","sequence":"additional","affiliation":[{"name":"3Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanming","family":"Zhang","sequence":"additional","affiliation":[{"name":"9Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8586-8500","authenticated-orcid":false,"given":"Wenbin","family":"Xiao","sequence":"additional","affiliation":[{"name":"9Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikhail","family":"Roshal","sequence":"additional","affiliation":[{"name":"9Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae H.","family":"Park","sequence":"additional","affiliation":[{"name":"1Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"},{"name":"2Cell Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 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