A review of the current status of lenalidomide maintenance therapy in multiple myeloma in 2022

ABSTRACT

Introduction

Recent advances in the diagnosis and management of multiple myeloma (MM) have improved patient outcomes. This progress in our understanding of MM has resulted in continuous suppressive therapy concepts, including induction, high dose chemotherapy with autologous stem cell transplantation (ASCT), consolidation, and maintenance therapy. The foundation of maintenance therapy has been with lenalidomide. Other novel immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), and targeted monoclonal antibodies have also contributed to this evolution.

Areas covered

This review summarizes the outcomes from phase II/III trials with long-term lenalidomide maintenance therapy alone or in combination with other agents in post-ASCT and non-transplant settings for newly diagnosed patients with MM. We review recent data considering a combination with newer medications and ongoing trials. We also review the optimal duration, MRD negativity rate, and safety and tolerability aspects of lenalidomide maintenance therapy. This review aims to present the current and emerging clinical evidence that supports using lenalidomide as a backbone for maintenance therapy in patients with MM.

Expert opinion

There is increasing evidence to support lenalidomide as the backbone of combination therapy in the maintenance setting.

KEYWORDS:

• Multiple myeloma
• lenalidomide
• maintenance therapy
• ASCT

Article highlights

• Multiple myeloma (MM) is a malignancy of plasma cells, with patients ultimately relapsing and being refractory to treatment.

• Maintenance lenalidomide has been shown to improve both progression-free survival (PFS) and overall survival (OS).

• A number of trials have demonstrated increased benefit of lenalidomide in combination with other agents, achieving higher MRD negativity and delaying relapse.

• The standard of care is to give maintenance until progression. The optimal duration is still unclear, and numerous trials are evaluating this currently.

Declaration of interest

PL McCarthy has served as a consultant and/or received honoraria from Bluebird Biotech, BMS, Celgene, Fate Therapeutics, Hikma, Janssen, Juno, Karyopharm, Magenta Therapeutics, Novartis, Oncopeptides, Partner Therapeutics, Sanofi, Starton Therapeutics and Takeda and received institutional research funding from BMS, Celgene, and Juno. J Hillengass has received honoraria from Janssen, Amgen, Curio Science, IntelliSphere and has served on advisory boards for Janssen, GSK, Axxess Network. SA Holstein has served as a consultant or member of an advisory board for BMS, Celgene, Genentech, GSK, Janssen, Oncopeptides, Sanofi, Secura Bio, Takeda and received research funding from Oncopeptides. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has received honoraria for lectures from: Ono, Takeda, Janssen, Sanofi and Bristol Myers Squibb and has received research funding from: Takeda, Janssen and Pfizer Bristol Myers Squibb.

Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

The authors have no funding to report.