Lenalidomide-based Regimens for Multiple Myeloma
Multiple myeloma is a type of cancer that affects certain type of white blood cells in the bone marrow called the plasma cells. Treatment for multiple myeloma includes bone marrow transplantation, radiation and chemotherapy. Chemotherapy earlier included two medications, melphalan and prednisone. Later, other medications like thalidomide, bortezomib and lenalidomide were added to these two drugs. These newer additions were found to enhance the benefits of chemotherapy in multiple myeloma patients.
A study was carried out on a group of individuals newly diagnosed with multiple myeloma over the age of 65 years who were not fit for transplantation. In this study, three chemotherapy regimens were compared on a three groups of patients: melphalan-prednisone-lenalidomide followed by lenalidomide maintenance therapy (MPR-R) in one group, melphalan-prednisone-lenalidomide without maintenance therapy (MPR) in the second group, and melphalan-prednisone without maintenance therapy (MP) in the third group.
The researchers found that patients on the MPR-R regimen had a reduced rate of progression of multiple myeloma as compared to those on the MPR or MP regimens. This benefit was greatest in patients between the ages of 65 and 75 years of age.
Side effects affecting the blood like a decrease in white blood cell count and platelets were observed more commonly in the groups receiving lenalidomide. Infections were also more common in these groups. Four deaths in the study were attributed to lenalidomide; among these 3 were due to infection. The incidence of serious adverse effects was low during maintenance treatment with lenalidomide.
The researchers suggest that an anticancer regimen that contains lenalidomide and includes a maintenance dosage of lenalidomide is thus preferable in multiple myeloma as compared to the older regimen of melphalan and prednisone alone. This is especially true in those individuals who are between the ages of 65 and 75 years and are not eligible for bone marrow transplantation.
Continuous Lenalidomide Treatment for Newly Diagnosed Multiple Myeloma; Antonio Palumbo et al; N Engl J Med 2012; 366:1759-1769.