Review of therapy for relapsed/refractory multiple myeloma: focus on lenalidomide

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.

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.

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.