Lenalidomide (Len) maintenance improves survival after upfront autologous stem cell transplantation (autoHCT) in multiple myeloma (MM), but its role after delayed/salvage autoHCT is less defined. We performed a retrospective study of 163 MM patients who received delayed (n = 102) or salvage (n = 61) autoHCT between 2009 and 2023, followed by Len maintenance. After median follow-up of 50 months, median progression-free survival (PFS) and overall survival (OS) were 23 (95% CI, 20-26) and 62 (95% CI, 50-80) months, respectively. Patients with high-risk cytogenetic abnormalities had inferior outcomes (PFS 8 months; OS 27 months). In multivariable analysis, achieving ≥ complete response post-transplant improved PFS (hazard ratio HR 0.49, p = 0.002) and OS (HR 0.44; p = 0.002). Len maintenance ≥5 years was associated with improved PFS (HR 0.19; p p = 0.002). Fourteen patients (9%) developed second primary malignancies. In conclusion, extended Len maintenance was associated with prolonged survival after delayed/salvage autoHCT.
Haider et al. (2026) studied this question.