Publication: Prolonged lenalidomide maintenance therapy improves the depth of response in multiple myeloma.
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Date
2020
Authors
Alonso, Rafael
Cedena, María-Teresa
Wong, Sandy
Shah, Nina
Ríos-Tamayo, Rafael
Moraleda, José M
López-Jiménez, Javier
García, Cristina
Bahri, Natasha
Valeri, Antonio
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Abstract
Lenalidomide is an immunomodulatory drug approved for maintenance treatment in newly diagnosed multiple myeloma, and it has been shown to improve progression-free survival (PFS) and, in several studies, overall survival. Nevertheless, the impact of prolonged treatment with lenalidomide on the kinetics of minimal residual disease (MRD) and its prognostic impact have not been studied in depth. To obtain better knowledge in this regard, we retrospectively analyzed 139 patients who received lenalidomide maintenance in real-world clinical practice and whose MRD levels were observed during the treatment period by multiparametric flow cytometry or next-generation sequencing with a sensitivity of at least 10-4. Lenalidomide maintenance correlated with an increased depth of the disease response, with 38.1% of patients achieving maximal response during maintenance. Moreover, 34.3% of patients who were MRD positive after induction treatment achieved MRD-negative status during maintenance and ultimately had improved PFS. Sequential MRD assessments identified patients with progressively decreasing MRD levels who also had better PFS outcomes, compared with patients not showing a decreasing pattern of MRD. These results support the role of maintenance therapy, not only to sustain, but also to increase the depth of disease response with a PFS benefit. In addition, MRD monitoring during maintenance identifies patients with better prognosis and may help in their clinical management.
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MeSH Terms
Humans
Lenalidomide
Multiple Myeloma
Neoplasm, Residual
Retrospective Studies
Treatment Outcome
Lenalidomide
Multiple Myeloma
Neoplasm, Residual
Retrospective Studies
Treatment Outcome