Lenalidomide (Len) is effective for relapsed and refractory multiple myeloma (RRMM). Recently, the European Myeloma Network (WMN) proposed the optimal starting dose of anti-myeloma drugs for elderly myeloma patients according to patient age and vulnerability (Palumbo A et al. Blood. 2011;118:4519). However, the feasibility of the recommendation has not been established. We therefore investigated transplantation-ineligible 16 patients with RRMM in order to evaluate the feasibility of the EMN recommendation.Methods
Sixteen transplantation-ineligible myeloma patients were included. We retrospectively investigated the starting dose, efficacy and tolerability of Len. We then compared the recommended doses of Len according to patient age and vulnerability to the actual doses of each patient. The response was assessed according to the IMWG criteria. Adverse events were graded according to CTCAE v3.0.Results
Median age was 72 years. Complication such as pulmonary or renal dysfunction was seen in 3 patients before the treatment with Len. Fraility was seen in 6 patients (4 mildly, 1 moderately, 1 severely). As the actual starting dose, Len was given at 25, 15 and 10 mg/day for 21 days every 28 days in nine, five and two patients, respectively. The mean number of treatment cycle was 9.3. The overall response rate was 64%. Grade 3 or 4 hematological and non-hematological adverse events were seen in 37.5% and 18.8%, respectively. The actual doses of Len corresponded with the recommended doses in 12 of 16 patients (75%). Nine of these 12 patients have been continuously treated with Len. Of the four patients who were treated with higher dose than the recommendation, three experienced severe adverse events and the treatment was interrupted in two of them.Conclusions
The starting dose modification of Len according to the EMN recommendation seems to be feasible for transplantation-ineligible myeloma patients. Prospective feasibility study should be warranted.