Review of therapy for relapsed/refractory multiple myeloma

PURPOSE OF REVIEW: Multiple myeloma is a malignant neoplasm of plasma cells, for which there is no known cure. This article examines the efficacy and tolerability of lenalidomide, a potent structural analogue of thalidomide, for second-line treatment of patients with relapsed multiple myeloma. RECENT FINDINGS: Lenalidomide, a thalidomide analogue, was designed to provide increased efficacy, while avoiding the adverse effects associated with thalidomide therapy. Studies assessing lenalidomide as second-line therapy for multiple myeloma have shown promising beneficial effects. Lenalidomide-dexamethasone is associated with significantly longer median time to disease progression and overall survival, as well as a significantly higher proportion of patients who respond to treatment compared with dexamethasone alone. Lenalidomide (with dexamethasone) was associated with a high rate of myelosuppression in clinical trials; neutropenia, infection, thrombocytopenia, and venous thromboembolism were common grade 3-4 adverse events. However, appropriate management of these adverse events maximizes the clinical benefit of lenalidomide. SUMMARY: Lenalidomide in combination with dexamethasone is approved by the US Food and Drug Administration and the European Medicines Agency for the second-line treatment of patients with multiple myeloma. Lenalidomide is recommended as a treatment option for patients with multiple myeloma in both United States and European treatment guidelines.