Department of Internal Medicine V, Multiple Myeloma Division, Heidelberg University Medical Center, Heidelberg, Germany.
Private Oncology Practice Ravensburg, Ravensburg, Germany.
Ann Hematol. 2020 Aug;99(8):1709-1725. doi: 10.1007/s00277-020-04023-4. Epub 2020 Apr 16.
Lenalidomide is an integral, yet evolving, part of current treatment pathways for both transplant-eligible and transplant-ineligible patients with newly diagnosed multiple myeloma (NDMM). It is approved in combination with dexamethasone as first-line therapy for transplant-ineligible patients with NDMM, and as maintenance treatment following autologous stem cell transplantation (ASCT). Although strong clinical trial evidence has supported the integration of lenalidomide into current treatment paradigms for NDMM, applying those paradigms to individual patients and determining which patients are most likely to benefit from lenalidomide treatment are more complex. In this paper, we utilize the available clinical trial evidence to provide recommendations for patient selection and lenalidomide dosing in both the first-line setting in patients ineligible for ASCT and the maintenance setting in patients who have undergone ASCT. In addition, we provide guidance on management of those adverse events that are most commonly associated with lenalidomide treatment, and consider the optimal selection and sequencing of next-line agents following long-term frontline or maintenance treatment with lenalidomide.
来那度胺是新诊断多发性骨髓瘤（NDMM）患者中适合移植和不适合移植患者当前治疗方案中不可或缺且不断发展的一部分。它与地塞米松联合获批用于不适合移植的 NDMM 患者的一线治疗，以及自体干细胞移植（ASCT）后的维持治疗。尽管强有力的临床试验证据支持将来那度胺纳入 NDMM 的当前治疗方案，但将这些方案应用于个体患者并确定哪些患者最有可能从来那度胺治疗中获益更为复杂。在本文中，我们利用现有临床试验证据，为不适合接受 ASCT 的患者的一线治疗以及已接受 ASCT 的患者的维持治疗中，提供关于患者选择和来那度胺剂量的建议。此外，我们还提供了与来那度胺治疗最常相关的不良事件管理的指导，并考虑了在长期一线或维持治疗后，来那度胺的最佳选择和序贯方案。
