Abstract
Multiple myeloma is the second most common hematologic malignancy. It accounts for 20,580 new cancer cases in the USA in 2009, including 11,680 cases in men, 8,900 cases in women, and 10,580 deaths overall. Although the disease remains still incurable, outcomes have improved substantially over recent years thanks to the use of high-dose therapy and the availability of novel agents, such as the immunomodulatory drugs thalidomide and lenalidomide, and the proteasome inhibitor bortezomib. Various trials have shown the advantages linked to the use of novel agents in the transplant and not-transplant settings. In particular, this paper will present an overview of the results achieved with lenalidomide-containing combinations in patients eligible for high-dose therapies, namely, young patients. The advantages obtained should always be outweighed with the toxicity profile associated with the regimen used. Therefore, here, we will also provide a description of the main adverse events associated with lenalidomide and its combination.
Highlights
For many years, the combination vincristine-doxorubicindexamethasone (VAD) was the standard induction treatment for young patients with multiple myeloma (MM) eligible for autologous stem cell transplantation (ASCT)
On the basis of two phase 3 clinical trials, lenalidomide has already shown additive and/or synergistic effects when used in association with dexamethasone [7,8,9]; this combination is at present indicated for patients with MM, who have received at least one previous therapy. [10, 11]
Patients assigned to treatment with RD had at least partial response (PR) of 78%, with very good PR (VGPR) of 63%, while the respective figures for dexamethasone alone were 48% and 16% (P < 0.001)
Summary
The combination vincristine-doxorubicindexamethasone (VAD) was the standard induction treatment for young patients with multiple myeloma (MM) eligible for autologous stem cell transplantation (ASCT). Differences between lenalidomide and thalidomide activity have been shown in preclinical studies. Thalidomide has more antiangiogenic activity than lenalidomide in human models. On the basis of two phase 3 clinical trials, lenalidomide has already shown additive and/or synergistic effects when used in association with dexamethasone [7,8,9]; this combination is at present indicated for patients with MM, who have received at least one previous therapy. New and ongoing trials are assessing the benefit of lenalidomide-combination therapies in early phase of treatment. Advances in Hematology lenalidomide, used in young patients either as induction or maintenance treatment
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