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Lenalidomide plus dexamethasone versus thalidomide plus dexamethasone in newly diagnosed multiple myeloma: a comparative analysis of 411 patients

2009; Elsevier BV; Volume: 115; Issue: 7 Linguagem: Inglês

10.1182/blood-2009-08-239046

1528-0020

Francesca Gay, Suzanne R. Hayman, Martha Q. Lacy, Francis K. Buadi, Morie A. Gertz, Shaji Kumar, Angela Dispenzieri, Joseph Mıkhael, P. Leif Bergsagel, David Dingli, Craig B. Reeder, John A. Lust, Stephen J. Russell, Vivek Roy, Steven R. Zeldenrust, Thomas E. Witzig, Rafaël Fonseca, Robert A. Kyle, Philip R. Greipp, A. Keith Stewart, S. Vincent Rajkumar,

Peripheral Neuropathies and Disorders

The objective of this case-control study was to compare the efficacy and toxicity of lenalidomide plus dexamethasone (len/dex) versus thalidomide plus dexamethasone (thal/dex) as initial therapy for newly diagnosed myeloma. We retrospectively studied 411 newly diagnosed patients treated with len/dex (228) or thal/dex (183) at the Mayo Clinic. The differences were similar in a matched-pair analysis that adjusted for age, sex, transplantation status, and dexamethasone dose. The proportions of patients achieving at least a partial response to len/dex and thal/dex were 80.3% versus 61.2%, respectively (P < .001); very good partial response rates were 34.2% and 12.0%, respectively (P < .001). Patients receiving len/dex had longer time to progression (median, 27.4 vs 17.2 months; P = .019), progression-free survival (median, 26.7 vs 17.1 months; P = .036), and overall survival (median not reached vs 57.2 months; P = .018). A similar proportion of patients in the 2 groups experienced at least one grade 3 or 4 adverse event (57.5% vs 54.6%, P = .568). Main grade 3 or 4 toxicities of len/dex were hematologic, mainly neutropenia (14.6% vs 0.6%, P < .001); the most common toxicities in thal/dex were venous thromboembolism (15.3% vs 9.2%, P = .058) and peripheral neuropathy (10.4% vs 0.9%, P < .001). Len/dex appears well-tolerated and more effective than thal/dex. Randomized trials are needed to confirm these results.