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This Week in NEJM: May 10, 2012

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In NEJM this week, an international team led by the University of Turin's Antonio Palumbo reports on the efficacy of continuous lenalidomide treatment for patients with newly diagnosed multiple myeloma. The team randomly assigned 459 patients who were ineligible for transplantation to receive either melphalan-prednisone-lenalidomide induction followed by lenalidomide maintenance therapy, melphalan-prednisone-lenalidomide without maintenance therapy, or melphalan-prednisone without maintenance therapy. After a median follow-up of 30 months, the team found that progression-free survival was significantly longer in the group receiving melphalan-prednisone-lenalidomide induction followed by lenalidomide maintenance therapy as compared with the other two groups. Response rates were also superior in this combination and maintenance therapy group. "MPR-R significantly prolonged progression-free survival in patients with newly diagnosed multiple myeloma who were ineligible for transplantation, with the greatest benefit observed in patients 65 to 75 years of age," Palumbo et al. write.

Also in NEJM this week, a team led by the Hôpital Purpan's Michel Attal reports on the efficacy of lenalidomide maintenance therapy following stem-cell transplantation in multiple myeloma patients. The researchers randomly assigned 614 patients younger than 65 with non-progressive disease after first-line transplantation to receive maintenance therapy with either lenalidomide or with placebo. They found that lenalidomide therapy improved median progression-free survival across all patient subgroups. "Lenalidomide maintenance after transplantation significantly prolonged progression-free and event-free survival among patients with multiple myeloma," the authors write. "Four years after randomization, overall survival was similar in the two study groups."

And finally in NEJM this week, researchers led by the Roswell Park Cancer Institute's Philip McCarthy also report on the efficacy of lenalidomide maintenance therapy after stem-cell transplantation in multiple myeloma patients. The team randomly assigned 460 patients younger than 71 years of age with stable disease, or a marginal, partial, or complete response 100 days after undergoing stem-cell transplantation to receive either lenalidomide or placebo. At a median follow-up time of 34 months, the researchers found a significantly longer time-to-disease-progression in the lenalidomide group, with 37 percent of the patients receiving lenalidomide showing disease progression, compared to 58 percent in the placebo group. "Lenalidomide maintenance therapy, initiated at day 100 after hematopoietic stem-cell transplantation, was associated with more toxicity and second cancers but a significantly longer time to disease progression and significantly improved overall survival among patients with myeloma," the authors write.