Nationwide implementation of lenalidomide maintenance in multiple myeloma: A retrospective, real‐world study

Abstract

Abstract Lenalidomide maintenance (LM) has shown benefit in progression‐free survival (PFS) and overall survival (OS) in clinical trials. LM is the recommended standard of care in patients with newly diagnosed multiple myeloma (MM) after high‐dose melphalan and autologous stem cell transplantation (HDM‐ASCT). In Denmark, LM has been approved and publicly funded for all patients treated with HDM‐ASCT since June 2019. Patients with newly diagnosed MM treated with their first HDM‐ASCT between June 2019 and March 2022 were included and followed until data cut‐off in June 2023. To compare outcomes, a historical pre‐LM cohort from the Danish MM Registry, consisting of 364 MM patients treated with HDM‐ASCT between June 2015 and June 2019, was used. Among 364 patients treated with HDM‐ASCT after June 2019, 22.3% received consolidation therapy and 3.7% underwent tandem HDM‐ASCT. During follow‐up, 297 patients (81.6%) initiated maintenance therapy, with 277 (76.1%) receiving LM. Overall, 145 patients (52.3%) discontinued LM most commonly due to toxicity 75 (51.7%), with fatigue (30.7%), cytopenia (25.3%), and neuropathy (17.3%) being the main reasons. In a 6‐month landmark analysis, early discontinuation did not negatively impact PFS or OS. The LM cohort had similar PFS, and OS compared to the pre‐LM cohort. The 3‐year PFS and OS rates in the LM cohort were 61% and 86%, respectively, while the pre‐LM cohort had a 3‐year PFS of 55% and a 3‐year OS of 89%. In conclusion, the introduction of LM as a nationwide treatment option in Denmark did not lead to improved clinical outcomes.

Keywords

• lenalidomide maintenance
• multiple myeloma
• real‐world evidence
• transplant eligible