Lenalidomide Maintenance Therapy for Multiple Myeloma: Is Longer Better?
Posted: Wednesday, November 10, 2021
Although maintenance therapy with lenalidomide is an effective strategy in the era of newer agents along with autologous stem cell transplantation (ASCT), the ideal duration of such therapy is less clear. However, findings from a recent study published in Blood Cancer Journal suggested lenalidomide maintenance 3 years or longer in duration may be associated with improved overall and progression-free survival. In addition, according to Shaji Kumar, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues, daratumumab-based therapies at relapse may also offer a significant benefit.
The retrospective study evaluated 213 patients treated at the Mayo Clinic between 2005 and 2016 and received lenalidomide maintenance post ACST. Survival outcomes were first assessed for lenalidomide maintenance therapy alone and then again for salvage therapies (with and without the monoclonal antibody daratumumab), which were implemented after maintenance therapy. These salvage regimens were selected at first relapse after maintenance therapy.
For post-ASCT lenalidomide maintenance, a median progression-free survival of 4 years (95% confidence interval [CI] = 3.4–4.5 years) was reported. However, median overall survival was not reached (5-year overall survival = 77%). Not including patients who discontinued treatment, lenalidomide maintenance regimens 3 years or longer were associated with a superior 5-year overall survival of 100%, versus 85% in regimens shorter than 3 years. The median progression-free survival was 7.2 years (95% CI = 6–8.5 years) in regimens 3 years or longer versus 4.4 years (95% CI = 4.3–4.5 years) in regimens shorter than 3 years. Additionally, progression-free survival after first relapse post maintenance seemed to be superior with daratumumab-based regimens (18.4 months; 95% CI = 10.9–25.9 months) than without daratumumab (8.9 months; 95% CI = 5.5–12.3 months).
Disclosure: The study authors reported no conflicts of interest.
