Repeated Lenalidomide Treatment in Patients With Relapsed Multiple Myeloma

Lenalidomide is an effective antimyeloma drug. The combination of lenalidomide with dexamethasone is nowadays the gold standard for treatment of relapsed multiple myeloma. The aim of this study was to analyze efficiency of repeated lenalidomide treatment in patients with relapsed and refractory multiple myeloma. From 2009 to 2015, 41 heavily pretreated patients were retrospectively evaluated. Lenalidomide was administered at the standard dose, and in combination with corticosteroids and chemotherapy. Before the second lenalidomide treatment, median of previous therapy lines was 3, all patients were refractory to the last treatment, 95 % of patients were bortezomib-refractory and 48 % had previous autologous transplantation. In the first lenalidomide treatment, 82.8 % of partial response or better response was reached and median progression-free survival was 15.2 months. In the second lenalidomide treatment, 14.2 % of partial remission or better response was reached. Median progression-free survival was 4.8 months and median overall survival was 11.9 months. No success-predicting risk factor in lenalidomide retreatment was found. Treatment results were significantly affected by a limited lenalidomide coverage in the Czech health care system. Repeated lenalidomide treatment is an effective therapeutic alternative for heavily pretreated patients with relapsed and refractory multiple myeloma. For indirect comparison, the results are comparable to treatment by pomalidomide or daratumumab.