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. 2013 Oct;27(10):2062-6.
doi: 10.1038/leu.2013.143. Epub 2013 May 7.

Long-term outcome with lenalidomide and dexamethasone therapy for newly diagnosed multiple myeloma

G Srivastava  1 , V Rana, M Q Lacy, F K Buadi, S R Hayman, A Dispenzieri, M A Gertz, D Dingli, S Zeldenrust, S Russell, A McCurdy, P Kapoor, R Kyle, S V Rajkumar, S Kumar
Affiliations

Long-term outcome with lenalidomide and dexamethasone therapy for newly diagnosed multiple myeloma

G Srivastava et al. Leukemia. 2013 Oct.

Abstract

The combination of lenalidomide and dexamethasone (Len-Dex) is a commonly used initial therapy for newly diagnosed multiple myeloma (MM). Although the initial response rates and toxicity are well known, long-term outcome is not well described. We studied 286 consecutive patients with newly diagnosed MM initially treated with Len-Dex. The median (range) age at diagnosis was 63 (28-92) years, 166 (58%) patients ≤ 65 years and 175 (61%) male. The median estimated duration on Len-Dex was 5.3 months with overall response (≥ partial response) of 72%, including 26% with very good partial response or better. The median overall survival (OS) from the diagnosis was not reached (NR) and the estimated 5-year survival was 71%. The median time to first disease progression, irrespective of transplant status, was 30.2 months. Overall, 143 (50%) patients underwent stem cell transplant. The median OS was NR for patients ≤ 70 years and 5.8 years for the older patients (P=0.01). The 5-year OS estimate for patients in International Staging System stage 1, 2 and 3 were 82, 65, and 44% respectively. There were 21 new second malignancies after MM diagnosis (6.6%). The median survival exceeding 7 years reflects the efficacy of novel agents. The risk of second malignancies doesn't appear to be excessive in this population.

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Conflict of interest statement

CONFLICT OF INTEREST

AD received research dollars from Celgene, Millenium, Pfizer, MAG received honoraria for lectures from Celgene, RK is on the monitoring committees for Celgene as well as their advisory board for secondary malignancies, SVK received research support for clinical trials form Celgene, Millennium, Novartis, Cephalon, Onyx, consulting Merck, Celgene, Onyx.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for OS and time to progression for all patients in study. Estimated 3 year and 5-year OS were 84% and 67%, respectively.
Figure 2
Figure 2
Kaplan–Meier curves comparing OS among patients less than 70 years (n=227 with median OS not reached) and more than 70 years (n=59 with median OS of 5.8 years) with P=0.002.
Figure 3
Figure 3
Kaplan–Meier curves comparing OS among International Staging System (ISS) stage I to III. 5-year OS estimate for patients in ISS stage 1, 2 and 3 were 82, 65, and 44 months.
Figure 4
Figure 4
(a) Kaplan–Meier curves comparing PFS among patients with high-risk cytogenetics (with median PFS of 1.4 years) as compared with standard risk (median PFS of 3.4 years) with P=0.0002. (b) Kaplan–Meier curves comparing OS among patients with high-risk cytogenetics (median OS of 5 years) as compared with standard risk (median OS not reached) with P=0.0001.
See this image and copyright information in PMC

References

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