Newly-diagnosed patients with multiple myeloma who are ineligible for stem-cell transplantation ought to be treated with lenalidomide plus low-dose dexamethasone until disease progression (Rd continuous treatment), according to the analysis of a phase 3 trial conducted last year, with updated outcomes recently published in the Journal of Clinical Oncology.1

To determine whether Rd continuous is a viable option for elderly patients, researchers evaluated data from 1623 patients with multiple myeloma, of which 567 (35%) were 76 years or older. Of those enrolled, patients were randomly assigned as follows: 535 to Rd continuous, 541 to lenalidomide plus low-dose dexamethasone for 72 weeks (Rd18), and 547 to melphalan, prednisone, and thalidomide (MPT).

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For all patients, Rd continuous reduced risk of progression or mortality by 31% (P < .001); 36% for those younger than 76 (P < .001), and 20% for those 76 or older (P = .084). There was also a 14-month improved median overall survival for patients 76 or older who received Rd continuous from those who received MPT.

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Despite discordant P-values, the authors concluded that newly-diagnosed patients with multiple myeloma who are ineligible for stem-cell transplantation ought to receive Rd continuous treatment, regardless of age. Adverse events were similar for patients treated with Rd continuous among age groups, though patients 76 years and older were more likely to have lenalidomide dose reductions.


  1. Hulin C, Belch A, Shustik C, Petrucci MT, Dührsen U, Lu J, et al. Updated outcomes and impact of age with lenalidomide and low-dose dexamethasone or melphalan, prednisone, and thalidomide in the randomized, phase III FIRST trial [published online ahead of print June 20, 2016]. J Clin Oncol. doi: 10.1200/JCO.2016.66.7295.