The risk of secondary primary malignancies after therapy for multiple myeloma

The development of a secondary primary malignancy (SPM) has become an important issue in myeloma management, given the remarkable improvement in survival afforded by the introduction of novel agents. Treatment with immunomodulatory derivatives, specifically lenalidomide, has recently been identified as a potential risk factor for SPM in several studies, especially in the maintenance setting. This study reviews potential mechanisms for development of SPM, incidence of SPM with different treatment regimens, risk factors associated with SPM and features of SPM after myeloma therapy. The incidence of SPM is discussed in the context of different settings in which lenalidomide is used during the course of the disease. No clear evidence indicates that lenalidomide alone is associated with SPM in the absence of other risk factors. Routine cancer surveillance, lifestyle modification to avoid cancer risk factors and prompt evaluation if new symptoms occur should be emphasized to patients who are on continuous myeloma therapy.