A new study finds a significant proportion of patients with multiple myeloma (MM) who receive lenalidomide maintenance will see their disease response deepen and many will achieve minimal residual disease negativity.
Long-term use of lenalidomide as a maintenance therapy in patients with multiple myeloma (MM) can increase the depth of response and improve overall outcomes, according to new research.
Lenalidomide has been found to boost progression-free survival when administered following induction therapy, but until now the impacts of prolonged use on minimal residual disease (MRD) kinetics and survival had not been studied in depth.
In a new study published in the journal Blood Advances, a team of investigators from the Spain and the United States retrospectively analyzed 139 patients who received lenalidomide in a real-world clinical setting and whose MRD levels were tracked by multiparametric flow cytometry or next-generation sequencing with a sensitivity of at least 10-4. The authors found that treatment with lenalidomide was linked with an increased depth of disease response.
Specifically, 38.1% of patients achieved maximum response during maintenance, and 34.3% of patients who entered maintenance therapy MRD-positive achieved MRD-negative status during maintenance therapy. Further analysis showed patients who had progressively decreasing MRD levels also had better progression-free survival (PFS) compared to those whose MRD levels were not decreasing during maintenance.
Coauthor Rafael Alonso Fernández, MD, of Complutense University of Madrid, in Spain, told The American Journal of Managed Care® his team was struck by the impact of the therapy, noting that they found patients whose MRD levels were decreasing obtained a survival benefit even if they never made it to MRD negativity.
“In fact, in our study, with all the inherent limitations, these patients did not show differences in PFS outcomes compared with those who eventually obtained MRD-negative,” he added.
This suggests that it might make sense for physicians to track patients’ progress using serial MRD assessments during maintenance, he said.
More broadly, Alonso said the study offers confirmation that lenalidomide deepens disease response in many patients in such a way as to boost survival.
In the study, Alonso and colleagues note that it took a long time for regulators to widely approve lenalidomide as a maintenance therapy. He said that could be due to a number of factors, including some concern that it might increase the risk of secondary primary neoplasms.
However, Alonso said the end result of that lengthy regulatory process was that regulators were able to glean a better understanding of the balance of risks and benefits of lenalidomide maintenance therapy, which in turn can better inform clinician’s decisions.
Asked if these findings would affect therapy for patients who are MRD-negative following induction therapy, Alonso said it would be difficult to draw broad conclusions from this study. However, he noted that they found a 26% relapse rate among subgroups that achieved MRD-negative status either during induction or maintenance therapy.
“Accordingly, it seems reasonable to think that these patients are not exempt from risk and they could also obtain some benefit from the maintenance treatment,” he said.
Alonso said he hopes further study helps provide additional information, such as whether it might be appropriate to suspend maintenance treatment if certain criteria are met. He said further analysis using a higher sensitivity for MRD will also be important to allow more for detailed decision-making.
Reference
Alonso R, Cedena MT, Wong S, et al. Prolonged lenalidomide maintenance therapy improves the depth of response in multiple myeloma. Blood Adv. 2020;4(10):2163‐2171. doi:10.1182/bloodadvances.2020001508
Homelessness Compounds Hospital Stay Challenges: Study Reveals Prolonged Discharge Struggles
March 28th 2024In this investigation, outcomes of interest were morbidity rate and length of hospital stay or a traumatic injury among a homeless population, and whether age and/or injury severity had an influence on that relationship—with implications for improving the discharge process for these patients.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
Risk for Second Primary Melanoma Increases After Primary Melanoma Diagnosis as Men Age
March 28th 2024A population-based cohort study out of Norway has found that older men have a higher risk of developing second primary invasive melanoma following an initial primary melanoma, suggesting the benefits of increased surveillance in these patients.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
Wearable Activity Tracker Data Enhance Patient Assessment in Lung Cancer
March 28th 2024This analysis included 119 patients with advanced lung cancer, who were evaluated on 3 facets of physical activity over 14 days of using the amuelink wearable device from Sony: metabolic equivalent tasks, distance walked, and steps taken.
Read More
CMS released a final rule to help patients obtain Children’s Health Insurance Program (CHIP) coverage and issued a proposed rule to update Medicare payment policies and rates for inpatient rehabilitation facilities; debate over if gift card incentives are acceptable in health care marketing.
Read More