The Effect of Duration of Lenalidomide Maintenance and Outcomes of Different Salvage Regimens in Patients with Multiple Myeloma (MM).

Abstract

The optimal duration of lenalidomide maintenance post-autologous stem cell transplant (ASCT) in Multiple Myeloma (MM), and choice of therapy at relapse post-maintenance, need further evaluation. This retrospective study assessed outcomes of patients with MM (n = 213) seen at Mayo Clinic, Rochester between 1/1/2005-12/31/2016 who received lenalidomide maintenance post-ASCT. The median PFS was 4 (95% CI: 3.4, 4.5) years from diagnosis of MM; median OS was not reached (5-year OS: 77%). Excluding patients who stopped lenalidomide maintenance within 3 years due to progression on maintenance, ≥3 years of maintenance had a superior 5-year OS of 100% vs. 85% in <3 years (p = 0.011). Median PFS was 7.2 (95% CI: 6, 8.5) years in ≥3 years vs. 4.4 (95% CI: 4.3, 4.5) years in <3 years (p < 0.0001). Lenalidomide refractoriness at first relapse was associated with inferior PFS2 [8.1 (95% CI: 6.4, 9.9) months vs. 19.9 (95% CI: 9.7, 30.2; p = 0.002) months in nonrefractory patients]. At first relapse post-maintenance, median PFS2 was superior with daratumumab-based regimens [18.4 (95% CI: 10.9, 25.9) months] versus regimens without daratumumab [8.9 (95% CI: 5.5, 12.3) months; p = 0.006]. Daratumumab + immunomodulatory drugs had superior median PFS2 compared to daratumumab + bortezomib [NR vs 1 yr (95% CI: 0.5, 1.5); p = 0.004].

• Authors: Matthew Ho, Saurabh Zanwar, Prashant Kapoor, Morie Gertz, Martha Lacy, Angela Dispenzieri, Suzanne Hayman, David Dingli, Francis Baudi, Eli Muchtar, Nelson Leung, Taxiarchis Kourelis, Rahma Warsame, Amie Fonder, Lisa Hwa, Miriam Hobbs, Robert Kyle, S Vincent Rajkumar, Shaji Kumar
• Journal: Blood cancer journal (Blood Cancer J) Vol. 11 Issue 9 Pg. 158 (09 22 2021) ISSN: 2044-5385 [Electronic] United States
• PMID: 34552051 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s).

Chemical References

• Lenalidomide

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Female
• Hematopoietic Stem Cell Transplantation
• Humans
• Lenalidomide (therapeutic use)
• Maintenance Chemotherapy
• Male
• Middle Aged
• Multiple Myeloma (drug therapy)
• Progression-Free Survival
• Retrospective Studies
• Salvage Therapy
• Transplantation, Autologous
• Treatment Outcome