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Low-Dose Regimen Found to Improve Myeloma Survival

Lenalidomide plus low-dose dexamethasone better than high-dose dexamethasone

MONDAY, Oct. 26 (HealthDay News) -- Lenalidomide plus low-dose dexamethasone is associated with better survival than lenalidomide plus high-dose dexamethasone for treating newly diagnosed multiple myeloma, according to a study published online Oct. 22 in The Lancet Oncology.

As part of an open-label trial, S. Vincent Rajkumar, M.D., from the Mayo Clinic in Rochester, Minn., and colleagues randomly assigned 445 patients with multiple myeloma to 25 mg lenalidomide plus high-dose dexamethasone or lenalidomide plus low-dose dexamethasone.

Within four cycles, the researchers found that high-dose dexamethasone was associated with significantly more complete or partial responses (79 versus 68 percent; odds ratio, 1.75). However, at one year, the low-dose dexamethasone group had significantly better overall survival (96 versus 87 percent), at which point the trial was stopped and high-dose patients were crossed over to the lower dose. In the first four months of treatment, high-dose dexamethasone was associated with significantly more grade 3 or worse toxicity (52 versus 35 percent) and significantly more deaths (5.4 versus 0.5 percent). The most common adverse effects were deep-vein thrombosis, fatigue, and infections, including pneumonia.

"High-dose dexamethasone might still have a role in the treatment of patients with acute renal failure caused by myeloma cast nephropathy, cord compression from myeloma, or aggressive refractory disease," Rajkumar and colleagues write.

Several authors reported financial or consulting relationships with pharmaceutical companies.

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