Lenalidomide Maintenance in Newly Diagnosed Multiple Myeloma
Posted: Friday, January 19, 2018
In patients with newly diagnosed, transplant-eligible multiple myeloma, lenalidomide maintenance beyond the achievement of a complete response seemed to improve overall survival, compared with stopping maintenance when a complete response is achieved; it did not, however, appear to improve progression-free survival and was associated with increased toxicity. These data from the multicenter phase III GMMG-MM5 trial were presented by Hartmut Goldschmidt, MD, of the University Hospital Heidelberg, Germany, and colleagues, at the 2017 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 400).
A total of 502 patients were equally randomized between four treatment arms: arm A1: doxorubicin with lenalidomide for 2 years (n=125); arm A2: cyclophosphamide with lenalidomide for 2 years (n=126); arm B1: doxorubicin with lenalidomide maintenance until achievement of a complete response (n=126); and arm B2: cyclophosphamide with lenalidomide maintenance until achievement of a complete response (n=125).
After a median follow-up of 60.1 months, median progression-free survival was not significantly different between the treatment arms: 43.2, 40.9, 35.9, and 35.7 months in arms A1, A2, B1, and B2, respectively. However, overall survival was significantly different among the groups, with 36-months survival rates of 82.9%, 85.2%, 75.1%, and 77.1% in arms A1, A2, B1, and B2, respectively.
To evaluate the benefit of 2 years versus response-adapted lenalidomide, arms A1 plus A2 and B1 plus B2 were pooled. Progression-free survival was not significantly different for response-adapted lenalidomide versus 2 years of maintenance, but patients receiving 2 years of lenalidomide had significantly better overall survival. Thus, the investigators recommend continuing lenalidomide maintenance beyond achievement of a complete response in this patient population.
