New multiple myeloma treatment options appear promising for patients aged 65 years and younger and for newly diagnosed patients who are ineligible for stem-cell transplantation, according to two studies published in the New England Journal of Medicine.

Antonio Palumbo, M.D., from the University of Turin in Italy, and colleagues randomized 273 patients aged 65 years or younger with multiple myeloma to high-dose melphalan plus stem-cell transplantation or melphalan-prednisone-lenalidomide consolidation therapy after induction.

In addition, 251 patients were randomized to lenalidomide maintenance therapy or no maintenance therapy. During a median follow-up period of 51.2 months, high-dose melphalan plus stem-cell transplantation correlated with significantly longer progression-free survival (median survival, 43.0 versus 22.4 months; hazard ratio for progression or death, 0.44) and overall survival (four-year overall survival, 81.6 versus 65.3 percent; hazard ratio for death, 0.55).

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Lenalidomide maintenance was associated with significantly longer median progression-free survival (41.9 versus 21.6 months; hazard ratio for progression or death, 0.47).

Lotfi Benboubker, M.D., from the Centre Hospitalier Régional Universitaire in Tours, France, and colleagues randomized 1,623 patients with myeloma to lenalidomide and dexamethasone (until disease progression or 18 cycles) or to melphalan-prednisone-thalidomide (MPT) for 72 weeks.

The researchers found that the median progression-free survival was 25.5, 20.7, and 21.2 months with continuous lenalidomide-dexamethasone, 18 cycles of lenalidomide-dexamethasone, and MPT, respectively (hazard ratio for progression or death, 0.72 and 0.70 for continuous lenalidomide-dexamethasone versus MPT and 18 cycles lenalidomide-dexamethasone, respectively).

“These two articles considerably further our understanding of therapy for myeloma and how to best integrate new agents to treat this disease,” write the authors of an accompanying editorial.

Several authors from the Palumbo study disclosed financial ties to pharmaceutical and biotechnology companies, including Celgene, which funded the study and also partially funded the Benboubker study.

  1. Palumbo, Antonio, MD, et al. “Autologous Transplantation and Maintenance Therapy in Multiple Myeloma.” The New England Journal of Medicine. DOI: 10.1056/NEJMoa1402888. September 4, 2014.
  2. Benboubker, Lotfi, MD, et al. “Lenalidomide and Dexamethasone in Transplant-Ineligible Patients with Myeloma.” The New England Journal of Medicine. DOI: 10.1056/NEJMoa1402551. September 4, 2014.