Lenalidomide maintenance therapy should be given to patients with multiple myeloma after autologous hematopoietic stem cell transplantation (auto-HCT) until disease progression or unacceptable toxicity, according to a study published in Cancer.1

Whether the risks of lenalidomide therapy post-auto-HCT outweigh the benefits is unclear. There is evidence that lenalidomide prolongs progression-free and overall survival, but there is also evidence that long term use of the drug results in toxicity and second primary malignancies.

Researchers conducted a retrospective analysis of data from 464 patients post-auto-HCT. Median patient age at time of transplant was 60.1 years; 82% had standard cytogenetic risk, 18% had high risk.

All patients received lenalidomide maintenance therapy, though the dose varied based on physician’s discretion.

Overall response post-auto-HCT was 97%. Median progression-free survival was 38 months; median overall survival was 78 months. Thirty-one percent of patients discontinued treatment due to disease progression; 20% discontinued due to toxicity. Three percent of patients had secondary primary malignancies, the median time to occurrence for which was 2.2 years.

The authors note, however, that low incidence of secondary primary malignancies may be due to short follow-up time. Another acknowledged limitation was not evaluating the relationship between induction regimen and incidence of malignancies.

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It is not discussed, either within the study or as a limitation of the study, whether lenalidomide dose affects toxicity or risk of secondary primary malignancies.

The authors conclude that lenalidomide maintenance is “the most practical approach” until toxicity or disease progression.

Reference

  1. Mian I, Milton DR, Shah N, et al. Prolonged survival with a longer duration of maintenance lenalidomide after autologous hematopoietic stem cell transplantation for multiple myeloma. Cancer. 2016 Sep 28. doi: 10.1002/cncr.30366 [Epub ahead of print]