Continuous lenalidomide and dexamethasone (cLD) treatment, with renally adapted lenalidomide dosing, was effective for most transplant-ineligible patients with myeloma and renal impairment. This according to a study of 535 patients with myeloma randomized to receive cLD until disease progression, 541 patients receiving lenalidomide-dexamethasone for 18 cycles, and 547 patients receiving melphalan-prednisone-thalidomide (MPT) for 12 cycles. Researchers found:

• Compared with MPT, cLD reduced the risk of progression or death in no (HR, 0.67), mild (HR, 0.70), and moderate (0.65) renal impairment subgroups.

• Overall survival benefits were observed with cLD vs MPT in no or mild renal impairment subgroups.

• Renal function improved from baseline in 52.6% of patients treated with
lenalidomide and dexamethasone.

• The safety profile of cLD was consistent across renal subgroups except for grade 3/4 anemia and rash, which increased with increasing severity of renal impairment.

Citation: Dimopoulos MA, Cheung MC, Roussel, et al. Impact of renal impairment on outcomes with lenalidomide and dexamethasone treatment in the FIRST trial, a randomized, open-label phase 3 trial in transplant-ineligible patients with multiple myeloma. [Published online ahead of print December 11, 2015]. Haematologica. doi: 10.3324/haematol.2015.133629.