Multiple Myeloma: A Practical Guide to Current Management

Multiple Myeloma: A Practical Guide to
Current Management
LENALIDOMIDE
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Is the combination of lenalidomide and dexamethasone
appropriate as front-line therapy for multiple myeloma?
And what about the use of lenalidomide in patients with
relapsed and refractory disease?
The combination of lenalidomide and dexamethasone
as induction therapy in the newly diagnosed patient was
first evaluated in a phase II trial at the Mayo Clinic
[Rajkumar 2004], where the regimen was used as
induction therapy for potential transplantation candidates.
Lenalidomide was administered orally at a daily dose of
25 mg on days 1 to 21. Dexamethasone 40 mg was
administered on days 1 to 4, 9 to 12, and 17 to 20. All
patients received aspirin once a day as DVT prophylaxis.
Four cycles (28 days each) of therapy were to be provided
for patients who were candidates for stem cell
transplantation. Responding patients who were not
candidates for stem cell transplantation were allowed to
continue therapy at the discretion of the study investigator.
In the study, the following were criteria for partial
response:
• At least 50% reduction in serum M protein;
• At least 90% reduction in urinary M protein or a
reduction to