MM-429: Impact of Prolonged Lenalidomide Maintenance (≥3 years) and Outcomes in Patients with Multiple Myeloma Post-Autologous Stem Cell Transplant

Abstract

Context Lenalidomide maintenance therapy after autologous stem cell transplantation (ASCT) is standard of care for patients with multiple myeloma (MM). However, optimal duration of maintenance, as well as factors predicting outcomes, need further evaluation. Objective To determine impact of duration of therapy and identify factors affecting outcome of lenalidomide maintenance. Design Retrospective study of consecutive patients with MM seen at Mayo Clinic, Rochester between 1/1/2005 and 12/31/2016. Patients or Other Participants Two hundred thirteen patients treated with lenalidomide-based maintenance post-ASCT were included. Main Outcomes Measures Progression-free survival (PFS), overall survival (OS), and impact of duration of therapy on PFS and OS. Results The median follow-up was 5.4 (95% CI: 4.9, 5.9) years from diagnosis. Median age at initiation of maintenance was 60 years (range: 35–76). Cytogenetics data were available in 202 (95%) patients; 31% (63/203) harbored high-risk cytogenetics based on the mSMART 3.0 criteria. The median PFS was 4 years (95% CI: 3.4, 4.5) from diagnosis of MM and 3 years (95% CI: 2.6, 3.5) from start of maintenance; median OS was not reached from diagnosis of MM (5-year OS: 77%). Excluding patients progressing within 3 years of starting maintenance (n=65), patients receiving ≥3 years of maintenance (n=48) had superior 5-year OS of 100% versus 88% in patients who received Conclusions Maintenance therapy with lenalidomide is well tolerated, and a longer duration (≥3 years) is associated with improvement in OS, irrespective of cytogenetic risk group and ISS stage.