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Comparative Study
. 2010 Feb 18;115(7):1343-50.
doi: 10.1182/blood-2009-08-239046. Epub 2009 Dec 11.

Lenalidomide plus dexamethasone versus thalidomide plus dexamethasone in newly diagnosed multiple myeloma: a comparative analysis of 411 patients

Francesca Gay  1 , Suzanne R Hayman, Martha Q Lacy, Francis Buadi, Morie A Gertz, Shaji Kumar, Angela Dispenzieri, Joseph R Mikhael, P Leif Bergsagel, David Dingli, Craig B Reeder, John A Lust, Stephen J Russell, Vivek Roy, Steven R Zeldenrust, Thomas E Witzig, Rafael Fonseca, Robert A Kyle, Philip R Greipp, A Keith Stewart, S Vincent Rajkumar
Affiliations
Comparative Study

Lenalidomide plus dexamethasone versus thalidomide plus dexamethasone in newly diagnosed multiple myeloma: a comparative analysis of 411 patients

Francesca Gay et al. Blood. .

Abstract

The objective of this case-control study was to compare the efficacy and toxicity of lenalidomide plus dexamethasone (len/dex) versus thalidomide plus dexamethasone (thal/dex) as initial therapy for newly diagnosed myeloma. We retrospectively studied 411 newly diagnosed patients treated with len/dex (228) or thal/dex (183) at the Mayo Clinic. The differences were similar in a matched-pair analysis that adjusted for age, sex, transplantation status, and dexamethasone dose. The proportions of patients achieving at least a partial response to len/dex and thal/dex were 80.3% versus 61.2%, respectively (P < .001); very good partial response rates were 34.2% and 12.0%, respectively (P < .001). Patients receiving len/dex had longer time to progression (median, 27.4 vs 17.2 months; P = .019), progression-free survival (median, 26.7 vs 17.1 months; P = .036), and overall survival (median not reached vs 57.2 months; P = .018). A similar proportion of patients in the 2 groups experienced at least one grade 3 or 4 adverse event (57.5% vs 54.6%, P = .568). Main grade 3 or 4 toxicities of len/dex were hematologic, mainly neutropenia (14.6% vs 0.6%, P < .001); the most common toxicities in thal/dex were venous thromboembolism (15.3% vs 9.2%, P = .058) and peripheral neuropathy (10.4% vs 0.9%, P < .001). Len/dex appears well-tolerated and more effective than thal/dex. Randomized trials are needed to confirm these results.

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Figures

Figure 1
Figure 1
TTP in the intention-to-treat population of patients treated with len/dex and thal/dex. (A) TTP in all patients, regardless of dexamethasone dose. (B) TTP in pair mates who received high-dose dexamethasone. Median TTP is provided in the figure. m indicates months.
Figure 2
Figure 2
PFS in the intention-to-treat population of patients treated with len/dex and thal/dex. (A) PFS in all patients, regardless of dexamethasone dose. (B) PFS in pair mates who received high-dose dexamethasone. Median PFS is provided in the figure. m indicates months.
Figure 3
Figure 3
OS in the intention-to-treat population of patients treated with len/dex and thal/dex. (A) OS in all patients, regardless of dexamethasone dose. (B) OS in pair mates who received high-dose dexamethasone. Median OS is provided in the figure. m indicates months.
Figure 4
Figure 4
Subgroup analysis of OS in the intention-to-treat population of patients treated with len/dex and thal/dex according to transplantation status. (A) OS in patients who received transplantation. (B) OS in patients in patients who did not receive transplantation. Median OS is provided in the figure. m indicates months.
See this image and copyright information in PMC

Comment in

  • Lenalidomide for multiple myeloma.
    Hutchinson L. Hutchinson L. Nat Rev Clin Oncol. 2010 May;7(5):241. doi: 10.1038/nrclinonc.2010.55. Nat Rev Clin Oncol. 2010. PMID: 20432526 No abstract available.

References

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