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Optimizing Lenalidomide-Based Therapy for Myeloma: Focus on Plasma Concentration

By: Kayci Reyer
Posted: Tuesday, October 6, 2020

According to research published in the Biological and Pharmaceutical Bulletin, many patients with multiple myeloma who discontinue lenalidomide plus low-dose dexamethasone treatment due to adverse events may benefit from therapeutic drug monitoring. Long-term adherence to the combination treatment is associated with high response rates and improved progression-free survival.

“Early optimization of lenalidomide therapy by measuring plasma concentration may help to prevent discontinuation of therapy leading to [progressive disease],” concluded Eishi Ashihara, MD, PhD, of Kyoto Pharmaceutical University, and colleagues.

Conducted at Kyoto Kuramaguchi Medical Center between May 2013 and February 2017, the study included 33 patients with relapsed or refractory multiple myeloma. Patients received oral lenalidomide on days 1 to 21 of every 28-day cycle and received dexamethasone on days 1, 8, 15, and 22. Patients were separated into two groups based on whether they did (modified) or did not (continuous) require therapeutic modification over three cycles of treatment. On day 7 of the first cycle, blood was collected from all patients 3 hours after lenalidomide administration.

The modified group experienced lower plasma concentration of lenalidomide and lower concentration/dose ratios versus the continuous group, suggesting a greater oral clearance. Although there was an inverse correlation between the estimated creatinine clearance rate and the concentration/dose ratio, lenalidomide concentrations in the plasma differed substantially across patients, an indication that such concentrations did not appear to be dependent on kidney function. These two findings suggest that monitoring patients with multiple myeloma for low concentration/dose ratios and low lenalidomide concentrations in the plasma may help to prevent modification or discontinuation of therapy.

Disclosure: For full disclosures of the study authors, visit

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