Long-term outcome with lenalidomide and dexamethasone therapy for newly diagnosed multiple myeloma

• Published in: Leukemia Vol. 27; no. 10; pp. 2062 - 2066
• Main Authors: Srivastava, G, Rana, V, Lacy, M Q, Buadi, F K, Hayman, S R, Dispenzieri, A, Gertz, M A, Dingli, D, Zeldenrust, S, Russell, S, McCurdy, A, Kapoor, P, Kyle, R, Rajkumar, S V, Kumar, S
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.10.2013; Nature Publishing Group
• Subjects: 692/308/409; 692/699/67/1059/99; 692/699/67/1990/804; Adult; Age; Aged; Aged, 80 and over; Anticoagulants; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer; Cancer Research; Care and treatment; Critical Care Medicine; Dexamethasone; Dexamethasone - administration & dosage; Diagnosis; Dosage and administration; Drug dosages; Drug therapy; Female; Follow-Up Studies; Hematology; Humans; Immunotherapy; Intensive; Internal Medicine; Leukemia; Male; Medical records; Medicine; Medicine & Public Health; Middle Aged; Multiple myeloma; Multiple Myeloma - diagnosis; Multiple Myeloma - drug therapy; Multiple Myeloma - mortality; Neoplasm Staging; Oncology; original-article; Patients; Physiological aspects; Prognosis; Retrospective Studies; Stem cell transplantation; Stem cells; Steroids; Survival; Survival Rate; Targeted cancer therapy; Thalidomide - administration & dosage; Thalidomide - analogs & derivatives; Toxicity; United States; United States > US; long-term outcome; secondary malignancy; multiple myeloma; lenalidomide
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/leu.2013.143

The combination of lenalidomide and dexamethasone (Len–Dex) is a commonly used initial therapy for newly diagnosed multiple myeloma (MM). Although the initial response rates and toxicity are well known, long-term outcome is not well described. We studied 286 consecutive patients with newly diagnosed MM initially treated with Len–Dex. The median (range) age at diagnosis was 63 (28–92) years, 166 (58%) patients ⩽65 years and 175 (61%) male. The median estimated duration on Len–Dex was 5.3 months with overall response (⩾partial response) of 72%, including 26% with very good partial response or better. The median overall survival (OS) from the diagnosis was not reached (NR) and the estimated 5-year survival was 71%. The median time to first disease progression, irrespective of transplant status, was 30.2 months. Overall, 143 (50%) patients underwent stem cell transplant. The median OS was NR for patients ⩽70 years and 5.8 years for the older patients ( P =0.01). The 5-year OS estimate for patients in International Staging System stage 1, 2 and 3 were 82, 65, and 44% respectively. There were 21 new second malignancies after MM diagnosis (6.6%). The median survival exceeding 7 years reflects the efficacy of novel agents. The risk of second malignancies doesn’t appear to be excessive in this population.