Impact of risk stratification on outcome among patients with multiple myeloma receiving initial therapy with lenalidomide and dexamethasone

• Published in: Blood Vol. 114; no. 3; pp. 518 - 521
• Main Authors: Kapoor, Prashant, Kumar, Shaji, Fonseca, Rafael, Lacy, Martha Q., Witzig, Thomas E., Hayman, Suzanne R., Dispenzieri, Angela, Buadi, Francis, Bergsagel, P. Leif, Gertz, Morie A., Dalton, Robert J., Mikhael, Joseph R., Dingli, David, Reeder, Craig B., Lust, John A., Russell, Stephen J., Roy, Vivek, Zeldenrust, Steven R., Stewart, A. Keith, Kyle, Robert A., Greipp, Philip R., Rajkumar, S. Vincent
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 16.07.2009; Americain Society of Hematology; American Society of Hematology
• Series: Clinical Trials and Observations
• Subjects: Adult; Aged; Biological and medical sciences; Chromosome Aberrations; Clinical Trials and Observations; Dexamethasone - administration & dosage; Disease-Free Survival; Female; Hematologic and hematopoietic diseases; Humans; Immunodeficiencies. Immunoglobulinopathies; Immunoglobulinopathies; Immunopathology; Lenalidomide; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Multiple Myeloma - diagnosis; Multiple Myeloma - drug therapy; Multiple Myeloma - mortality; Plasma Cells; Prognosis; Remission Induction; Retrospective Studies; Risk Assessment; Survival Rate; Thalidomide - administration & dosage; Thalidomide - analogs & derivatives; Treatment Outcome; Antineoplastic agent; Human; Corticosteroid; Immunopathology; Dexamethasone; Prognosis; Hematology; Lenalidomide; Steroid hormone; Malignant hemopathy; Myeloma; Treatment; Immunoglobulinopathy; Lymphoproliferative syndrome; Risk factor; Cancer
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2009-01-202010

The outcome of patients with multiple myeloma is dictated primarily by cytogenetic abnormalities and proliferative capacity of plasma cells. We studied the outcome after initial therapy with lenalidomide-dexamethasone among 100 newly diagnosed patients, risk-stratified by genetic abnormalities and plasma cell labeling index. A total of 16% had high-risk multiple myeloma, defined by the presence of hypodiploidy, del(13q) by metaphase cytogenetics, del(17p), IgH translocations [t(4;14), or t(14;16)] or plasma cell labeling index more than or equal to 3%. Response rates were 81% vs 89% in the high-risk and standard-risk groups, respectively. The median progression-free survival was shorter in the high-risk group (18.5 vs 36.5 months, P < .001), but overall survival was comparable. Because of unavailability of all tests for every patient, we separately analyzed 55 stringently classified patients, and the results were similar. In conclusion, high-risk patients achieve less durable responses with lenalidomide-dexamethasone compared with standard-risk patients; no significant differences in overall survival are apparent so far. These results need confirmation in larger, prospectively designed studies.