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Maintenance Therapy Without Steroids Feasible in Elderly Myeloma Patients

WEDNESDAY, March 24, 2021 -- Dose/schedule-adjusted lenalidomide-dexamethasone (Rd) followed by a maintenance regimen of lenalidomide 10 mg/day without dexamethasone (Rd-R) is feasible for older patients with multiple myeloma (MM), with survival outcomes similar to those seen with standard continuous Rd, according to a study published online March 19 in Blood.

Alessandra Larocca, M.D., Ph.D., from the University of Torino in Italy, and colleagues examined the efficacy and feasibility of Rd-R versus continuous Rd in a randomized, phase III trial involving 199 elderly intermediate-fit, newly diagnosed MM patients (101 received Rd-R and 98 received continuous Rd). Participants were followed for a median of 37 months.

The researchers found that the best response rates were comparable between the groups, with at least a partial response rate of 78 and 68 percent in the Rd-R and continuous Rd groups, respectively (P = 0.15). Event-free survival was 10.4 and 6.9 months with Rd-R and continuous Rd, respectively (hazard ratio, 0.70; 95 percent confidence interval, 0.51 to 0.95; P = 0.02). Median progression-free survival was 20.2 versus 18.3 months (hazard ratio, 0.78; 95 percent confidence interval, 0.55 to 1.10; P = 0.16), while overall survival at three years was 74 and 63 percent, respectively (hazard ratio, 0.62; 95 percent confidence interval, 0.37 to 1.03; P = 0.06). The rate of at least one nonhematologic grade ≥3 adverse event was 33 versus 43 percent (P = 0.14).

"We expect the results of this study may help to improve and optimize the treatment of elderly patients who may be at greater risk of treatment toxicity and poor survival due to their age or comorbidities," Larocca said in a statement.

Several authors disclosed financial ties to the biopharmaceutical industry.

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