Blood Cancer Journal (Sep 2021)

The Effect of Duration of Lenalidomide Maintenance and Outcomes of Different Salvage Regimens in Patients with Multiple Myeloma (MM)

  • Matthew Ho,
  • Saurabh Zanwar,
  • Prashant Kapoor,
  • Morie Gertz,
  • Martha Lacy,
  • Angela Dispenzieri,
  • Suzanne Hayman,
  • David Dingli,
  • Francis Baudi,
  • Eli Muchtar,
  • Nelson Leung,
  • Taxiarchis Kourelis,
  • Rahma Warsame,
  • Amie Fonder,
  • Lisa Hwa,
  • Miriam Hobbs,
  • Robert Kyle,
  • S. Vincent Rajkumar,
  • Shaji Kumar

DOI
https://doi.org/10.1038/s41408-021-00548-7
Journal volume & issue
Vol. 11, no. 9
pp. 1 – 10

Abstract

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Abstract The optimal duration of lenalidomide maintenance post-autologous stem cell transplant (ASCT) in Multiple Myeloma (MM), and choice of therapy at relapse post-maintenance, need further evaluation. This retrospective study assessed outcomes of patients with MM (n = 213) seen at Mayo Clinic, Rochester between 1/1/2005–12/31/2016 who received lenalidomide maintenance post-ASCT. The median PFS was 4 (95% CI: 3.4, 4.5) years from diagnosis of MM; median OS was not reached (5-year OS: 77%). Excluding patients who stopped lenalidomide maintenance within 3 years due to progression on maintenance, ≥3 years of maintenance had a superior 5-year OS of 100% vs. 85% in <3 years (p = 0.011). Median PFS was 7.2 (95% CI: 6, 8.5) years in ≥3 years vs. 4.4 (95% CI: 4.3, 4.5) years in <3 years (p < 0.0001). Lenalidomide refractoriness at first relapse was associated with inferior PFS2 [8.1 (95% CI: 6.4, 9.9) months vs. 19.9 (95% CI: 9.7, 30.2; p = 0.002) months in nonrefractory patients]. At first relapse post-maintenance, median PFS2 was superior with daratumumab-based regimens [18.4 (95% CI: 10.9, 25.9) months] versus regimens without daratumumab [8.9 (95% CI: 5.5, 12.3) months; p = 0.006]. Daratumumab + immunomodulatory drugs had superior median PFS2 compared to daratumumab + bortezomib [NR vs 1 yr (95% CI: 0.5, 1.5); p = 0.004].