Evaluating the effectiveness of lenalidomide-containing triplet regimens in patients with first relapsed multiple myeloma.

This study evaluated the effectiveness of lenalidomide (Revlimid)-containing regimens in patients with first relapsed multiple myeloma (MM). The data showed that daratumumab (Darzalex) combined with lenalidomide and dexamethasone (Rd) regimen significantly increased the survival without cancer worsening with fewer serious side effects compared to carfilzomib (Kyprolis) combined with Rd regimen in these patients.

Multiple myeloma (MM) is a type of cancer that comes from blood cells called plasma cells. A high number of patients with MM experience relapse (the tumor grows after treatment) or are refractory (not responsive to the treatment) to standard treatment. Currently, the treatment strategies for r/r MM are based on the different combinations of conventional drugs and novel drugs. The standard treatment combination in patients with newly diagnosed MM is lenalidomide in combination with dexamethasone (Rd).

Lenalidomide is an immunotherapy drug that boosts the body’s immune system to help it attack cancer cells. Daratumumab is an immunotherapy drug that directly targets cancer cells to kill them. Carfilzomib is a proteasome inhibitor. Proteasomes are large molecules present in all body cells. It blocks the action of proteasomes, therefore preventing cancer cells from growing and multiplying. 

Daratumumab combined with the Rd regimen (D-Rd) and carfilzomib combined with the Rd regimen (K-Rd) are standard of care regimens used in lenalidomide-sensitive patients with first-relapsed MM. The effectiveness of lenalidomide-containing regimens in patients with first relapsed MM has not been compared in real-life practice.

The study involved 316 patients with MM in first relapse. Patients were divided into 2 groups based on the treatment combinations they received. Group 1 included 217 patients who received the D-Rd regimen. Group 2 included 99 patients who received the K-Rd regimen. The average follow-up time was 19 months for group 1 and 40 months for group 2.

The average survival without cancer worsening was 29.8 months for group 1 versus 22.5 months for group 2. This difference was statistically significant.

There was no significant difference in overall survival and overall response rate (complete or partial disappearance of cancer cells) between the two groups. After 2 years, 100% of group 1 and 98.1% of group 2 were alive. 

Patients in group 1 experienced less serious side effects compared to patients in group 2. The most common side effects were blood-related and infections. The rate of stopping treatment was 80% lower in group 1 (25.8%) compared to group 2 (58.6%).

This study concluded that the D-Rd regimen significantly increased the survival without cancer worsening with less serious side effects compared to the K-Rd regimen in patients with first relapsed MM.

This study looked back in time at medical records. The sample size was very small. This study only included patients treated at institutions in Italy.