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15-05-2012 | General practice | Article

Lenalidomide benefits in multiple myeloma reported

Abstract

Free abstract

MedWire News: Lenalidomide maintenance following melphalan-prednisone-lenalidomide induction (MPR-R) appears to significantly lengthen progression-free survival (PFS) in newly diagnosed multiple myeloma patients deemed unsuitable for transplantation, study findings suggest.

Research in TheNew England Journal of Medicine indicates that multiple myeloma patients assigned to the maintenance arm (MPR-R) lived without relapse or disease progression for at least twice as long as patients treated with only melphalan-prednisone-lenalidomide (MPR) or melphalan-prednisone (MP), followed with placebo.

The team compared the efficacy of MPR-R, MPR, and MP treatment regimens in 459 patients. The MPR-R regimen consisted of nine 4-week cycles of MPR plus lenalidomide maintenance until disease relapse or progression, whereas MPR and MP involved the same patterns of the respective treatments, but without the maintenance phase.

PFS in the MPR-R group compared with the MPR and MP groups was 31 months versus 14 and 13 months, respectively. This equates to hazard ratios for progression in the MPR-R group of 0.49, compared with the MPR group and 0.40, compared with the MP group, report Antonio Palumbo (University of Turin, Italy) and colleagues.

However, the significant survival benefit associated with MPR-R treatment was found only in patients aged 65-75 years, and not in older patients.

Grade 4 neutropenia during induction therapy was significantly more common in the MPR-R and MPR arms than the MP treatment group (35 vs 32 and 8%, respectively). Secondary cancer was also a concern, occurring in 7% of patients given MPR-R and MPR versus just 3% of MP-treated patients.

Ashraf Badros (University of Maryland School of Medicine, Baltimore, USA) comments on the results in an editorial. He calls the PFS rate obtained with lenalidomide maintenance therapy "impressive," when compared with MPR and MP without maintenance therapy, but concludes: "Whether these data establish a new standard of care for myeloma may be debatable."

By Josephine McCoan

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