Safety of lenalidomide for maintenance treatment of patients with multiple myeloma following autologous stem cell transplantation

ABSTRACT

Introduction

Myeloma is the second most common hematological cancer, with 5800 cases per year diagnosed in the UK. Despite improved treatment it is still considered non-curable, although the median survival has increased from 3 to 8 years over the past 20 years. Treatment involves the use of induction therapy and consolidation with autologous stem cell transplant (ASCT) in patients deemed fit enough. Further attempts to improve outcomes include the use of maintenance therapy.

Areas covered

This review details all trials in which lenalidomide has been used as maintenance following ASCT. PubMed searches included randomized control trials, observational cohort, reviews, and meta-analysis.

Expert opinion

Lenalidomide is a well-tolerated, oral agent that is associated with increased overall and progression free survival when used as maintenance following ASCT. Its use in this setting is FDA and EMA approved and is standard of care in Europe and North America. The early link between lenalidomide and second hematological cancers appears to be associated with use in combination with melphalan. There is an increase in non-melanoma skin cancers and solid tumors in the elderly but this has minimal impact on mortality. Lenalidomide use as part of combination maintenance is underway and may further improve outcomes.

KEYWORDS:

• Lenalidomide
• immunomodulatory agent
• maintenance
• continuous therapy
• overall survival
• progression free survival

Declaration of interest

JR Jones has received honoraria and research funding from Celgene. GH Jackson has received honoraria, research funding and speakers bureau from Takeda, Janssen, Amgen, GlaxoSmithKline and Celgene. C Pawkyn has served as a consultant for, and received travel expenses and honoraria from, Takeda, Celgene, Janssen and Amgen. 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.