Can Lenalidomide Delay Disease Progression of Smoldering Multiple Myeloma?
Posted: Monday, November 25, 2019
Although observation is currently the standard of care for patients with smoldering multiple myeloma, early intervention with lenalidomide may delay disease progression of symptomatic multiple myeloma, according to a study published in the Journal of Clinical Oncology. S. Vincent Rajkumar, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues reported that lenalidomide also appeared to delay the onset of bone and other myeloma-related organ damage. Patients with high-risk smoldering multiple myeloma appear to gain the greatest benefit from therapy.
“These results...support a change in the standard of care for intermediate and high-risk smoldering myeloma patients,” Dr. Rajkumar concluded in a Mayo Clinic press release. “It is too early to determine the impact of treatment on overall survival,” however, he added.
The investigators randomly assigned 182 patients with intermediate- or high-risk smoldering multiple myeloma to receive lenalidomide (n = 92) or observation (n = 90). The researchers defined disease progression as the development of end-organ damage that was attributed to multiple myeloma and biochemical disease progression.
After a median follow-up of 35 months, half of the patients in the lenalidomide arm responded to therapy, whereas no responses were recorded among patients in the observation arm. The progression-free survival was significantly longer among patients treated with lenalidomide compared with observation (P = .002). The 1-, 2-, and 3-year progression-free survival rates were all higher with lenalidomide than with observation (98%, 93%, and 91% vs. 89%, 76%, and 66%, respectively). The researchers reported two deaths in the lenalidomide arm and four deaths in the observation arm. Overall, 25 patients who received lenalidomide experienced grade 3 or 4 nonhematologic adverse events.
Disclosure: For full disclosures of study authors, visit ascopubs.org.