Optimizing the use of lenalidomide in relapsed or refractory multiple myeloma: Consensus statement

Department of Clinical Therapeutics, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece.
Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K (Impact Factor: 10.43). 02/2011; 25(5):749-60. DOI: 10.1038/leu.2011.3
Source: PubMed


An expert panel convened to reach a consensus regarding the optimal use of lenalidomide in combination with dexamethasone (Len/Dex) in patients with relapsed or refractory multiple myeloma (RRMM). On the basis of the available evidence, the panel agreed that Len/Dex is a valid and effective treatment option for most patients with RRMM. As with other therapies, using Len/Dex at first relapse is more effective regarding response rate and durability than using it after multiple salvage therapies. Len/Dex may be beneficial regardless of patient age, disease stage and renal function, although the starting dose of lenalidomide should be adjusted for renal impairment and cytopenias. Long-term treatment until there is evidence of disease progression may be recommended at the best-tolerated doses of both lenalidomide and dexamethasone. Recommendations regarding the prevention and management of adverse events, particularly venous thromboembolism and myelosuppression, were provided on the basis of the available evidence and practical experience of panel members. Ongoing trials will provide more insight into the effects of continuous lenalidomide-based therapy in myeloma.

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Available from: Heinz Ludwig, Aug 12, 2014
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    • "In fact, it is reported that adjusted dosing of lenalidomide to patients with renal dysfunction resulted with similar anti-myeloma efficacy to those with normal renal function [39, 40], and recovery of renal function was also observed [41]. Similar to bortezomib, cases that withdrew from dialysis are reported [42]. Stratified analysis of lenalidomide/dexamethasone therapy by age showed similar efficacy and tolerability in elderly (over 65 years of age) to those of youth [43]. "
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    • "Treatment with conventional chemotherapy results in response rates of about 50%, with only few patients achieving complete remission (CR) [2] and with a median survival of around 33 months [3]. Newer treatment regimens induce higher response rates [4] [5] [6] [7] [8] [9], a better quality of response, and long-term disease control with favourable tolerance [2] [10]. "
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    • "Therefore , it would be interesting to further investigate whether these molecules can serve as potential biomarkers of response to lenalidomide . Such considerations are important , as risk - adjusted therapy is becoming an important consider - ation when deciding on the most effective treatment regimens for MM patients ( Richardson , 2005 ; Shaffer et al , 2009 ; Dimopoulos et al , 2011 ) . Therefore , despite the clinical caveats , the data presented here confirm and extend the relevance of IRF4 as a prognostic factor and therapeutic target in MM , and indicate that lenalidomide decreases IRF4 expression . "
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