Triplet lenalidomide-based regimens did not induce any advantage over a double lenalidomide-based regimen in elderly patients with multiple myeloma, a study published online ahead of print in the journal Blood has shown.1

Although lenalidomide-dexamethasone has improved outcomes in elderly patients with newly diagnosed multiple myeloma, triplet regimens containing lenalidomide are also used. Therefore, researchers sought to compare the effect of triplet lenalidomide-based regimens with the doublet regimen lenalidomide plus low-dose dexamethasone.

For the study, researchers enrolled 662 patients 65 years of age or older or who were ineligible to undergo hematopoietic stem cell transplantation. Participants were randomly assigned to receive induction with cyclophosphamide or melphalan plus prednisone and lenalidomide, or lenalidomide plus low-dose dexamethasone.

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Results showed that after a median follow-up of 39 months, the median progression-free survival for the triplet regimens was 22 months compared with 21 months for the doublet regimen (P = .284). Median overall survival was not reached in either arm, and there was no statistically significant difference in 4-year overall survival between the 2 groups (67% vs 58%, respectively; P = .709).

When looking at each regimen separately, the investigators observed no difference in outcome between the 3.

In terms of safety, the most common grade 3 or higher toxicity was neutropenia, which occurred in 64% of patients who received melphalan, 29% of those who had cyclophosphamide, and 25% of patients who received the doublet regimen (P < .0001). There was no difference in grade 3 or higher non-hematologic toxicities between the 3 arms.

“In the overall population, the alkylator-containing triplets [melphalan plus prednisone with lenalidomide] and [cyclophosphamide plus prednisone with lenalidomide] were not superior to the alkylator-free doublet [lenalidomide plus low-dose dexamethasone], which was associated with lower toxicity,” the investigators concluded.


  1. Magarotto V, Bringhen S, Offidani M, et al. Triplet vs doublet lenalidomide-containing regimens for the treatment of elderly patients with newly diagnosed multiple myeloma [published online ahead of print January 4, 2015]. Blood. doi: 10.1182/blood-2015-08-662627.