Treatment Slowing Progression in Multiple Myeloma

New England Journal research found early lenalidomide (Revlimid®) and dexamethasone delays progression and prolongs survival in high-risk multiple myeloma.

Multiple myeloma, which is extremely rare, is a cancer of the bone marrow. It is caused by uncontrolled growth of plasma cells, a type of white blood cell that forms part of the immune system. Plasma cells normally produce immunoglobulins, or antibodies, belonging to the immune system. When plasma cells multiply uncontrollably and produce excessive quantities of a single type of immunoglobulin, a dangerous reduction in other immunoglobulins occurs. This leaves the patient vulnerable to infections. In addition, cancer cells accumulating in the bone marrow and bones may form tumors that damage bone tissue, weakening bones and causing fractures.

Standard treatment observes patients until symptoms develop, but this poorly serves high-risk individuals who could benefit from early intervention.

According to research results published in the New England Journal of Medicine, early treatment with lenalidomide (Revlimid®) and dexamethasone delays disease progression and prolongs survival in patients with high-risk multiple myeloma.

Lenalidomide, taken orally as a tablet, slows or stops the growth of cancerous myeloma cells in the bone marrow. Its use in combination with dexamethasone (cortisone) in patients with multiple myeloma was confirmed by a recent study, and the results were shared with the public.

The study enrolled 119 high-risk patients seeking treatment or observation. Treatment was given at 4-week intervals for 9 courses, on days 1-21 with daily 25 mg lenalidomide plus on days 1-4 and 12-15 daily 20 mg dexamethasone. Maintenance continued for 2 years, every 28 days on days 1-21 with daily 10 mg lenalidomide. Primary endpoint was progression; secondary endpoints were response, overall survival and safety.

After an average follow-up of 40 months, the average time to disease progression was observed to be longer in the treatment group than in the observation group. Indeed, while the average time to cancer progression was 21 months in the observation group, no progression was recorded during follow-up in the treatment group. Furthermore, 3-year survival was significantly higher in the treatment group (%94) than in the observation group (%80). During the first phase of the study, a partial or positive response was achieved in %79 of treated patients. The partial or positive response rate in the next phase was %90.

In conclusion, treatment was well tolerated. Although a respiratory tract infection occurred in one patient, no significant treatment-related side effects were recorded across the study participants overall.

The findings therefore confirm that early treatment in patients with high-risk multiple myeloma delays disease progression and prolongs survival. Positive results in such a difficult cancer should be regarded as a success and should lead the way for further research.