Lenalidomide plus dexamethasone vs. lenalidomide plus melphalan and prednisone: a retrospective study in newly diagnosed elderly myeloma |
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| Authors: | Francesca Gay S Vincent Rajkumar Patrizia Falco Shaji Kumar Angela Dispenzieri Maria Teresa Petrucci Morie A Gertz Mario Boccadoro A Keith Stewart Antonio Palumbo |
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| Institution: | 1. Department of Internal Medicine, Division of Hematology, Mayo Clinic College of Medicine, Rochester, MN, USA;2. Divisione Universitaria di Ematologia, Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy;3. Day Hospital Di Ematologia – S.O.C. di Immunoematologia e Medicina Trasfusionale, Ospedale di Ivrea, Italy;4. Dipartimento di Biotecnologie e Ematologia, Università La Sapienza, Roma, Italy;5. Division of Hematology/Oncology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA |
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| Abstract: | Background: The goal of this retrospective study was to compare the efficacy and toxicity of lenalidomide–dexamethasone (len/dex) vs. melphalan–prednisone–lenalidomide (MPR) as upfront therapy for newly diagnosed elderly patients with myeloma. Methods: Data from 51 patients enrolled in an Italian phase I/II trial and treated with MPR were analyzed and compared with data from 38 patients, seen at the Mayo Clinic, treated with len/dex and enrolled in phase II/III trials. Results: On intention‐to‐treat analysis, time to progression (median: 24.7 vs. 27.5 months in MPR and len/dex groups, respectively, P = 0.903), progression‐free survival (median: 24.7 vs. 27.5 months in MPR and len/dex groups, respectively, P = 0.926), and overall survival (2‐yr overall survival: 86.2% in MPR vs. 89.1% in len/dex, P = 0.730) were not significantly different between the two groups. Results were confirmed when the analysis was restricted to MPR and len/dex matched pair mates. Hematologic grade 3–4 toxicities were more common with MPR (neutropenia: 66.7% vs. 21.1%, P < 0.001; thrombocytopenia: 31.4% vs. 2.6%, P < 0.001). Grade 3–4 gastrointestinal events (13.2% vs. 3.9%, P = 0.132), thrombotic events (13.2% vs. 5.9%, P = 0.279), and fatigue (10.5% vs. 3.9%, P = 0.395) were more common with len/dex. Conclusions: Results show that both MPR and len/dex are efficacious regimens for elderly patients with myeloma. Randomized trials are needed to confirm these results. |
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| Keywords: | myeloma melphalan lenalidomide steroids |
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