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
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.
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
Continuous Lenalidomide Treatment for Newly Diagnosed Multiple Myeloma;
Antonio Palumbo et al; N Engl J Med 2012; 366:1759-1769.