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Lenalidomide maintenance in myeloma

Nature Reviews Clinical Oncology volume 9, page 605 (2012)Cite this article

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I thank Gozzetti and colleagues for their comments on my News & Views article (Haematological cancer: Lenalidomide maintenance—perils of a premature denouement. Nat. Rev. Clin. Oncol. 9, 372–374; 2012).1 In their letter (Lenalidomide maintenance in myeloma. Nat. Rev. Clin. Oncol. doi:10.1038/nrclinonc.2012.100-c1),2 they remark that patients in complete response may not benefit from lenalidomide maintenance. I fully agree. Indeed, in my commentary I went one step further and recommended that lenalidomide be considered only in patients who are not either in complete response or very good partial response (VGPR). In myeloma, VGPR refers to >90% reduction in tumour burden. An important concept is that, in myeloma, 'complete response' as currently defined is just a greater intensity of VGPR—rarely does it reflect true 100% eradication of the clone.

Approximately 30% of patients with myeloma are in complete response after transplant, and about 60% are in VGPR.3,4 Thus, recommending lenalidomide to patients who are not in complete response will result in 70% of patients being considered for such an approach, whereas using the VGPR benchmark will result in 40% of patients being considered for maintenance. At this point, for the reasons I discussed in my commentary, I recommend consideration of lenalidomide maintenance only in patients who are not in complete response or VGPR following initial therapy. Whether such therapy is termed 'maintenance' or 'consolidation' is a matter of semantics—just as the term complete response itself.

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References

  1. Rajkumar, S. V. Haematological cancer: Lenalidomide maintenance—perils of a premature denouement. Nat. Rev. Clin. Oncol. 9, 372–374 (2012).

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  2. Gozzetti, A., Defina, M. & Bocchia, M. Lenalidomide maintenance in myeloma. Nat. Rev. Clin. Oncol. http://dx.doi.org/10.1038/nrclinonc.2012.100-c1.

  3. McCarthy, P. L. et al. Lenalidomide after stem-cell transplantation for multiple myeloma. N. Engl. J. Med. 366, 1770–1781 (2012).

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  4. Attal, M. et al. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N. Engl. J. Med. 366, 1782–1791 (2012).

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  1. Division of Hematology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, 55905, MN, USA

    S. Vincent Rajkumar

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  1. S. Vincent Rajkumar
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Rajkumar, S. Lenalidomide maintenance in myeloma. Nat Rev Clin Oncol 9, 605 (2012). https://doi.org/10.1038/nrclinonc.2012.100-c2

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