TY - JOUR
T1 - Lenalidomide plus dexamethasone versus thalidomide plus dexamethasone in newly diagnosed multiple myeloma
T2 - A comparative analysis of 411 patients
AU - Gay, Francesca
AU - Hayman, Suzanne R.
AU - Lacy, Martha Q.
AU - Buadi, Francis
AU - Gertz, Morie A.
AU - Kumar, Shaji
AU - Dispenzieri, Angela
AU - Mikhael, Joseph R.
AU - Bergsagel, P. Leif
AU - Dingli, David
AU - Reeder, Craig B.
AU - Lust, John A.
AU - Russell, Stephen J.
AU - Roy, Vivek
AU - Zeldenrust, Steven R.
AU - Witzig, Thomas E.
AU - Fonseca, Rafael
AU - Kyle, Robert A.
AU - Greipp, Philip R.
AU - Stewart, A. Keith
AU - Rajkumar, S. Vincent
PY - 2010/2/18
Y1 - 2010/2/18
N2 - 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), progressionfree 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.
AB - 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), progressionfree 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.
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U2 - 10.1182/blood-2009-08-239046
DO - 10.1182/blood-2009-08-239046
M3 - Article
C2 - 20008302
AN - SCOPUS:77949890246
SN - 0006-4971
VL - 115
SP - 1343
EP - 1350
JO - Blood
JF - Blood
IS - 7
ER -