Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Long-term response to lenalidomide in patients with newly diagnosed multiple myeloma

Leukemia volume 28, pages 455–457 (2014)Cite this article

Subjects

Lenalidomide is an immunomodulatory (IMid) drug that is commonly used to treat newly diagnosed and relapsed multiple myeloma (MM).1 Clinical observations in patients with newly diagnosed MM suggest that some patients are able to attain long-term remissions after treatment with immunomodulatory drugs, some of which may be sustained for several years.2 In this study, our goal was to identify predictive factors among those patients who were induced with and continued on lenalidomide for ⩾3 years (long-term responders (LTRs)).

Between 2003 and 2011, 305 patients with newly diagnosed active MM, who received initial treatment with lenalidomide and dexamethasone, were seen at the Mayo Clinic, Rochester. Complete clinical, laboratory and treatment data were available for 284 patients and were extracted after retrospective review of their medical records. The Mayo Foundation Institutional Review Board approved the study, and all patients consented to have their medical records reviewed according to the institutional review board practices. One hundred and nine patients were excluded leaving 175 patients for the current study. Reasons for exclusion included early autologous stem cell transplant in 103 and less than 3 years of follow-up in 6. Patients were treated with lenalidomide 25 mg daily for 21 days of a 28-day cycle. Initial patients were treated with high-dose dexamethasone (40 mg on days 1–4, 9–12, 17–20 of a 28-day cycle), which was changed to 40 mg weekly once the results of the E4A03 clinical trial were reported.3 All patients had disease assessment after each cycle of treatment, and the International Myeloma Working Group (IMWG) uniform response criteria were used to assess disease response. Outside of a clinical trial setting, a bone marrow was not always performed for confirmation of a complete response (CR). Overall survival (OS) and progression-free survival (PFS) were estimated by the method of Kaplan–Meier. The Pearson χ2-test and the Kruskal–Wallis tests were used to ascertain differences between nominal and continuous variables, respectively. P-values less than 0.05 were considered significant. All statistics were done using JMP software (SAS, Carey, NC, USA).

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Dimopoulos MA, Kastritis E, Rajkumar SV . Treatment of plasma cell dyscrasias with lenalidomide. Leukemia 2008; 22: 1343–1353.

    Article  CAS  Google Scholar 

  2. Richardson PG, Laubach JP, Schlossman RL, Ghobrial IM, Redman KC, McKenney M et al. The potential benefits of participating in early-phase clinical trials in multiple myeloma: long-term remission in a patient with relapsed multiple myeloma treated with 90 cycles of lenalidomide and bortezomib. Eur J Haematol 2012; 88: 446–449.

    Article  CAS  Google Scholar 

  3. Rajkumar SV, Jacobus S, Callander NS, Fonseca R, Vesole DH, Williams ME et al. Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol 2010; 11: 29–37.

    Article  CAS  Google Scholar 

  4. Srivastava G, Rana V, Lacy MQ, Buadi FK, Hayman SR, Dispenzieri A et al. Long-term outcome with lenalidomide and dexamethasone therapy for newly diagnosed multiple myeloma. Leukemia 2013; 27: 2062–2066.

    Article  CAS  Google Scholar 

  5. Mikhael JR, Dingli D, Roy V, Reeder CB, Buadi FK, Hayman SR et al. Management of newly diagnosed symptomatic multiple myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines 2013. Mayo Clinic proc 2013; 88: 360–376.

    Article  Google Scholar 

  6. Dingli D, Pacheco JM, Nowakowski GS, Kumar SK, Dispenzieri A, Hayman SR et al. Relationship between depth of response and outcome in multiple myeloma. J Clin Oncol 2007; 25: 4933–4937.

    Article  Google Scholar 

  7. van Rhee F, Bolejack V, Hollmig K, Pineda-Roman M, Anaissie E, Epstein J et al. High serum-free light chain levels and their rapid reduction in response to therapy define an aggressive multiple myeloma subtype with poor prognosis. Blood 2007; 110: 827–832.

    Article  CAS  Google Scholar 

  8. Boccadoro M, Marmont F, Tribalto M, Fossati G, Redoglia V, Battaglio S et al. Early responder myeloma: kinetic studies identify a patient subgroup characterized by very poor prognosis. J Clin Oncol 1989; 7: 119–125.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported in part by the JABBS Foundation, the Predolin Foundation and the Robert A Kyle Hematologic Malignancies Fund. Research funding was provided to Angela Dispenzieri by Celgene, Janssen Pharmaceuticals and Millennium Pharmaceuticals. Shaji K Kumar also received research funding from Celgene, Millennium Pharmaceuticals, Onyx.

Author contributions

Conception and design: Angela Dispenzieri; provision of study materials of patients: all authors; collection and assembly of data: all authors; data analysis and interpretation: Taxiarchis V Kourelis, Angela Dispenzieri, Shaji Kumar; writing of manuscript and final approval of manuscript: all authors.

Author information

Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    T V Kourelis, S K Kumar, G Srivastava, M A Gertz, M Q Lacy, F K Buadi, R A Kyle & A Dispenzieri

Authors
  1. T V Kourelis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S K Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G Srivastava
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M A Gertz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M Q Lacy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F K Buadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R A Kyle
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A Dispenzieri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A Dispenzieri.

Ethics declarations

Competing interests

Shaji K Kumar is a consultant for Celgene, Millennium Pharmaceuticals, Onyx. Morie Gertz and Martha Q Lacy have received honoraria from Celgene.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kourelis, T., Kumar, S., Srivastava, G. et al. Long-term response to lenalidomide in patients with newly diagnosed multiple myeloma. Leukemia 28, 455–457 (2014). https://doi.org/10.1038/leu.2013.300

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/leu.2013.300

This article is cited by

Search

Advanced search

Quick links