Revlimid maintenance for myeloma – pro

As per the 2010 ASCO meeting and the two studies presented there, maintenance treatment is beneficial after an autologous transplant for multiple myeloma and the CALGB s100104 study was stopped based on positive results. That trial of  568 multiple myeloma patients ages 18 to 70 included  participants who had an autologous stem cell transplant. 460 patients were randomized to receive Revlimid maintenance therapy or placebo. Due to the significant difference in time to progression between the two groups, the study has been stopped, patients have been informed about which maintenance therapy they were receiving, and all patients have been given the option to receive Revlimid.

There is also randomized and phase II evidence to support maintenance thalidomide. In a 2012 NEJM study,  Lenalidomide maintenance after transplantation significantly prolonged progression-free and event-free survival among patients with multiple myeloma. Four years after randomization, overall survival was similar in the two study groups. NCCN has incorporated lenalidomide maintenance, as well as interferon, steroids and thalidomide with or without prednisone into its guidelines. NCCN supports Revlimid maintenance after allogeneic or autlogous transplant., Multiple Myeloma. MYEL-6

Michel Attal, M.D., Valerie Lauwers-Cances, M.D., Gerald Marit, M.D., Denis Caillot, M.D., Philippe Moreau, M.D., Thierry Facon, M.D., Anne Marie Stoppa, M.D., Cyrille Hulin, M.D., Lofti Benboubker, M.D., Laurent Garderet, M.D., Olivier Decaux, M.D., Serge Leyvraz, M.D., Marie-Christiane Vekemans, M.D., Laurent Voillat, M.D., Mauricette Michallet, M.D., Brigitte Pegourie, M.D., Charles Dumontet, M.D., Murielle Roussel, M.D., Xavier Leleu, M.D., Claire Mathiot, M.D., Catherine Payen, M.D., Hervé Avet-Loiseau, M.D., and Jean-Luc Harousseau, M.D. for the IFM Investigators Lenalidomide Maintenance after Stem-Cell Transplantation for Multiple Myeloma N Engl J Med 2012; 366:1782-1791May 10, 2012

P. L. McCarthy, K. Owzar, K. C. Anderson, C. C. Hofmeister, H. Hassoun, D. D. Hurd, E. A. Stadtmauer, S. Giralt, V. Hars, C. A. Linker, for CALGB, ECOG and BMT-CTN; Roswell Park Cancer Institute, Buffalo, NY; Duke University Medical Center, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; The Ohio State University, Columbus, OH; Memorial Sloan-Kettering Cancer Center, New York, NY; Wake Forest University, Winston Salem, NC; University of Pennsylvania Cancer Center, Philadelphia, PA; University of Texas M. D. Anderson Cancer Center, Houston, TX; University of California, San Francisco, San Francisco, (ASCT) for multiple myeloma (MM): CALGB 100104. CAJ Clin Oncol 28:15s, 2010 (suppl; abstr 8017)

M. Attal, C. Cristini, G. Marit, D. Caillot, T. Facon, C. Hullin, P. Moreau, C. Mathiot, H. Avet-Loiseau, J. L. Harousseau, Intergroupe Francophone du Myelome; Hematology Department, CHU Purpan, Toulouse, France; CHU Toulouse, Toulouse, France; Service d’Oncologie Médicale, Hôpital du Haut Leveque CHU de Bordeaux, Bordeaux, France; Hematology Department, CHU Le Bocage, Dijon, France; Hôpital Claude Huriez, Lille, France; Hematology Department, CHU Brabois, Nancy, France; Hematology Department, University Hospital, Nantes, France; Hematology Laboratory, Institut Curie, Paris, France; Hematology Laboratory, University Hospital, Nantes, France; IFM, Nantes, France , Lenalidomide maintenance after transplantation for myeloma. J Clin Oncol 28:15s, 2010 (suppl; abstr 8018)

Chang JE, Juckett MB, Callander NS, Kahl BS, Gangnon RE, Mitchell TL, Longo WL. Thalidomide maintenance following high-dose melphalan with autologous stem cell support in myeloma. Clin Lymphoma Myeloma. 2008 Jun;8(3):153-8.
Abdelkefi A, Ladeb S, Torjman L, Othman TB, Lakhal A, Romdhane NB, Omri HE, Elloumi M, Belaaj H, Jeddi R, Aissaouï L, Ksouri H, Hassen AB, Msadek F, Saad A, Hsaïri M, Boukef K, Amouri A, Louzir H, Dellagi K, Abdeladhim AB; Tunisian Multiple Myeloma Study Group. Single autologous stem-cell transplantation followed by maintenance therapy with thalidomide is superior to double autologous transplantation in multiple myeloma: results of a multicenter randomized clinical trial. Blood. 2008 Feb 15;111(4):1805-10.
Harousseau JL, Moreau P. Evolving role of stem cell transplantation in multiple myeloma. Clin Lymphoma Myeloma. 2005 Sep;6(2):89-95.
Spencer A, Prince HM, Roberts AW, Prosser IW, Bradstock KF, Coyle L, Gill DS, Horvath N, Reynolds J, Kennedy N. Consolidation therapy with low-dose thalidomide and prednisolone prolongs the survival of multiple myeloma patients undergoing a single autologous stem-cell transplantation procedure. J Clin Oncol. 2009 Apr 10;27(11):1788-93.
Kumar A, Kharfan-Dabaja MA, Glasmacher A, Djulbegovic B. Tandem versus single autologous hematopoietic cell transplantation for the treatment of multiple myeloma: a systematic review and meta-analysis. J Natl Cancer Inst. 2009 Jan 21;101(2):100-6. Epub 2009 Jan 13.

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