Lenalidomide as maintenance treatment
Lenalidomide maintenance treatment has proven to be much better tolerated than thalidomide as a maintenance treatment with far fewer patients needing to discontinue treatment because of side effects.
Results of four large randomised controlled studies, including the largest myeloma trial Myeloma XI, showed a progression free survival advantage for lenalidomide maintenance, with an OS benefit highlighted in two of the trials. Associated adverse events including neutropenia and thrombocytopenia were identified but were relatively well tolerated. In early 2021, lenalidomide became the first maintenance treatment for myeloma to be made available through the NHS in England, Scotland and Wales. It is now the gold standard globally for patients who have received HDT-SCT to increase remission time and improve OS.
In this setting, lenalidomide is administered as an oral monotherapy on a 3 weeks on, 1 week off cycle and is given until no longer tolerated or when there is disease progression.