Lenalidomide Can Delay Bone and Organ Damage for Smoldering Myeloma Patients

Posted: Nov 01, 2019

In the largest ever study of smoldering myeloma patients from 13 major myeloma facilities, lenalidomide was found to delay disease progression, and helped prevent bone damage and end organ damage. The study was run by the Eastern Cooperative Oncology Group and funded by the National Cancer Institute.

The study included 182 intermediate or high risk smoldering myeloma patients (between 2013-2017) who were broken into two groups:

90 patients received 25 mg of lenalidomide
90 patients were observed with no therapy.

The median follow up was 35 months. Progression free survival (PFS) was analyzed from years 1-3 and it was too soon to assess Overall Survival.

	Lenalidomide	No Treatment
PFS 1 YR	98%	89%
PFS 2 YRS	93%	76%
PFS 3 YRS	91%	66%

Six deaths were reported - two in the lenalidomide arm and four in the observation arm. Study authors noted:

"Our data, together with the results of the Spanish trial, support early therapy as the new standard of care in high-risk SMM on the basis of clear clinical benefit in the prevention of end-organ damage demonstrated in two independent randomized trials."

They conclude that patients with high-risk smoldering myeloma by Mayo 2018 criteria, (which was recently validated by the International Myeloma Working Group), gained the greatest benefit from early therapy and are the only group for whom they recommended early intervention using lenalidomide or lenalidomide plus dexamethasone.

"Curative" treatment strategies are also being evaluated for high risk smoldering myeloma patients. Such a study is the ECOG-ACRIN study, comparing daratumumab, lenalidomide, and dexamethasone (with the goal of a cure) vs. lenalidomide plus dexamethasone (with the goal of prevention). The future results from this study can be compared to this current study and will provide clarity on the best long-term strategy for high risk smoldering myeloma. While we are waiting on those results, lead study author Vincent Rajkumar, MD of the Mayo Clinic said:

"Early treatment with lenalidomide delays progression to symptomatic myeloma and can prevent damage to organs that occurs in multiple myeloma."

about the author
Jennifer Ahlstrom

Myeloma survivor, patient advocate, wife, mom of 6. Believer that patients can help accelerate a cure by weighing in and participating in clinical research. Founder of HealthTree Foundation (formerly Myeloma Crowd).