Advantageous use of lenalidomide in multiple myeloma: discussion of three case studies

Although multiple myeloma remains an essentially incurable disease, treatment options and patients' quality of life have improved over the last years with the introduction of more effective and less toxic agents. Therapy should be tailored to the clinical circumstance of each patient under consideration of factors such as patient age, comorbidities (e.g. history of renal failure, thromboembolism or neuropathy) and performance status.

This article presents three Portuguese clinical cases, illustrating the efficacy and good tolerability profile of lenalidomide in combination with dexamethasone, especially when used as second-line therapy. In particular, these cases illustrate the benefit of using such combinations in patients previously treated with thalidomide as well as patients with peripheral neuropathy or renal impairment. Finally, the last case highlights the importance of timely administration of effective thromboembolism prophylaxis in the presence of prothrombotic risk factors.

These cases are discussed in light of the current knowledge of achieving the best quality of life for the patients, while minimizing myeloma burden and improving existing organ damage due to either the presence of multiple myeloma or to previous therapies.