Long term therapy with lenalidomide improves outcome, survival in multiple myeloma
Patients with multiple myeloma treated with long term lenalidomide therapy have improved survival, primarily following stem-cell transplantation.
Multiple myeloma is a cancer of plasma cells of bone marrow that can damage the bones, immune system, kidneys and red blood cells. Current therapy usually includes chemotherapy and stem-cell transplantation.
The study assessed lenalidomide maintenance therapy versus observation in patients with newly diagnosed multiple myeloma, including patients with cytogenetic high-risk disease and transplantation status subgroups.
After a follow-up of 31 months,  progression-free survival was 39 months (95% CI 36–42) with lenalidomide and 20 months (18–22) with observation
The Myeloma XI trial that involved newly diagnosed patients of multiple myeloma showed that ongoing therapy with lenalidomide showed improvement in outcomes when compared to patients not receiving the drug.
This large trial was done at 110 National Health Service hospitals in England, Wales, and Scotland and was published in The Lancet Oncology.
Out of 1917 patients 18 years or older, 1137 patients were randomly assigned to lenalidomide maintenance and 834 patients to observation between Jan 13, 2011, and Aug 11, 2017 – this was after they had completed their initial treatment. After a follow-up of 31 months,  progression-free survival was 39 months (95% CI 36–42) with lenalidomide and 20 months (18–22) with observation. Progression-free survival was improved with lenalidomide compared with observation across all prespecified subgroups. The most common serious adverse events were infections in both the lenalidomide group and the observation group, and no deaths in the lenalidomide group were deemed treatment related.
The study found that maintenance therapy with lenalidomide significantly improved progression-free survival in patients with newly diagnosed multiple myeloma compared with observation.
In patients with high-risk disease, relapse is the result of the persistence of residual disease, even at very low levels. The newer, better tolerated, immunomodulatory agent lenalidomide could overcome the limitations of present mainstay drug thalidomide as maintenance therapy in this setting as it improved progression-free survival and overall survival in patients with newly diagnosed multiple myeloma.
For patients with multiple myeloma who are ineligible for transplantation, continuous therapy with lenalidomide plus low-dose dexamethasone improved progression-free survival and overall survival compared with presently available combination therapy of melphalan, prednisone, and thalidomide.
