Is lenalidomide a good choice as maintenance treatment in multiple myeloma?

This study examined whether multiple myeloma (MM) can become resistant to lenalidomide (Revlimid) when this drug is used as maintenance therapy (MT) after bone marrow transplant. The authors found that using lenalidomide when the cancer came back after lenalidomide MT was not associated with resistance and improved the outcomes of patients with MM.

Multiple myeloma (MM) is cancer happening in the bone marrow, in which plasma cells grow out of control and do not produce antibodies. As the cancer cells can crowd the bone marrow, the other types of cells produced by bone marrow cannot be made at a normal rate, thus leading to anemia (a shortage of red blood cells), low levels of platelets (cells involved in clotting), and a higher chance of infections. 

Patients with MM can receive an autologous stem cell transplant (ASCT). This involves the transplant of healthy blood stem cells from the patient into the bone marrow to replace the damaged cells. This is possible because stem cells can become any cells of the body. 

Lenalidomide is an immuno-modulator drug. This means it is able to regulate and/or normalize the immune system. Lenalidomide can be used as part of initial or second-line treatment regimens or can be used as MT after an ASCT. MT is given after an initial treatment to prevent the cancer from returning. Usually, MT is given long-term at low doses. Even with MT, the cancer can still come back. In this case, salvage treatments are needed. It is not known whether lenalidomide MT (LMT) can cause resistance in case MM returns and patients need further treatments containing lenalidomide. 

This study included 575 patients who received an ASCT as first-line treatment. Patients were divided into 4 groups. Group 1 included 136 patients who received LMT after ASCT followed by further lenalidomide-based regimens after relapse. Group 2 included 161 patients who received LMT and other chemotherapy at relapse. Group 3 included 209 patients who did not receive LMT but had lenalidomide therapy after relapse. Group 4 included 69 patients who did not receive LMT or lenalidomide-based therapy after relapse.

In the groups that received LMT, there was no difference in survival without cancer worsening after 2 years. However, patients in group 1 had a significantly longer overall survival (55.3 months) compared to group 2 (37.9 months). There was no significant difference in overall survival between group 1 (55.3 months) and group 3 (49 months).

This study concluded that LMT followed by further lenalidomide-based second-line treatments at relapse may improve survival in patients with MM undergoing ASCT. 

This study is based on data from medical records. Information might have been missing. This might have influenced the results. 

Discuss with your doctor about receiving LM maintenance.