Kidney issues are a common complication for multiple myeloma patients. It can be present in up to 30-35% of newly diagnosed myeloma and is related to a poor outcome. However, early recognition and early treatments can overcome the negative impact of renal impairment and even reverse kidney damage in most cases. The immunomodulator lenalidomide is traditionally used in myeloma care but can be hard on the kidneys. Lenalidomide dose reductions are common with renal insufficiency, but Italian researchers wanted to see if there was a way to use the full dose by modifying the dose schedule and not the dose level. In the study, researchers tested the use of 25 mg of lenalidomide every other day. The overall response ratio was 66.5%. More than half of the patients (61.1%) had a renal response. The median progression-free survival was 8 months (range: 3–18 months). No serious adverse events occurred during treatment, and it was never necessary to disrupt or delay treatment for toxicity. The authors suggest that there might be significant therapeutic effect of lenalidomide, at the dose of 25 mg every other day for 21 days, with logistic and economic advantages but caution that the results should be validated by controlled studies involving larger numbers of patients. Ask your doctor if this strategy might be right for you.