Wang M et al. (2008) Lenalidomide plus dexamethasone is more effective than dexamethasone alone in patients with relapsed or refractory multiple myeloma regardless of prior thalidomide exposure. Blood 112: 4445–4451

Multiple myeloma remains an incurable disease and novel treatments are urgently needed. Clinical studies have shown that lenalidomide is an effective treatment for patients with multiple myeloma. Two prospective, randomized, phase III trials in patients with relapsed or refractory multiple myelomas demonstrated that lenalidomide plus dexamethasone significantly improved response rate and overall survival compared with placebo plus dexamethasone.

Wang and colleagues carried out a prospective analysis using data from two clinical trials to assess the efficacy of lenalidomide plus dexamethasone in patients with multiple myeloma who had previously been treated with thalidomide. A total of 704 patients who had relapsed or refractory multiple myelomas were randomly assigned to receive oral lenalidomide plus dexamethasone or placebo plus dexamethasone.

Compared with the placebo arm, the combination of lenalidomide plus dexamethasone resulted in higher overall response rate, longer progression-free survival and longer time to progression. The overall response rate was higher in patients treated with lenalidomide plus dexamethasone who had no previous exposure to thalidomide, than in those who had been previously exposed to it. Regardless of previous exposure to thalidomide, the combination of lenalidomide and dexamethasone resulted in higher levels of infections, venous thromboembolism and myelosuppression compared with placebo.

The authors conclude that lenalidomide plus dexamethasone is superior to dexamethasone alone in the treatment of patients with relapsed or refractory myeloma.