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Lenalidomide for the treatment of relapsed and refractory multiple myeloma

Authors Van De Donk, Gorgun G, Groen, Jakubikova, Mitsiades C, Hideshima T, Laubach J, Nijhof, Raymakers, Lokhorst H, Richardson P, Anderson K

Received 1 June 2012

Accepted for publication 19 July 2012

Published 14 August 2012 Volume 2012:4 Pages 253—268


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Niels WCJ van de Donk,1,2 Güllü Görgün,1 Richard WJ Groen,1,3 Jana Jakubikova,1 Constantine S Mitsiades,1 Teru Hideshima,1 Jacob Laubach,1 Inger S Nijhof,2 Reinier A Raymakers,2 Henk M Lokhorst,2 Paul G Richardson,1 Kenneth C Anderson1
1Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; 2Department of Hematology, 3Department of Cell Biology, University Medical Center Utrecht, Utrecht, The Netherlands

Abstract: Lenalidomide is an amino-substituted derivative of thalidomide with direct antiproliferative and cytotoxic effects on the myeloma tumor cell, as well as antiangiogenic activity and immunomodulatory effects. Together with the introduction of bortezomib and thalidomide, lenalidomide has significantly improved the survival of patients with relapsed and refractory myeloma. The most common adverse events associated with lenalidomide include fatigue, skin rash, thrombocytopenia, and neutropenia. In addition, when lenalidomide is combined with dexamethasone or other conventional cytotoxic agents, there is an increase in the incidence of venous thromboembolic events. There is now evidence that continued treatment with lenalidomide has a significant impact on survival by improving the depth and duration of response. This highlights the value of adverse event management and appropriate dose adjustments to prevent toxicity, and of allowing continued treatment until disease progression. In this review, we will discuss the different lenalidomide-based treatment regimens for patients with relapsed/refractory myeloma. This is accompanied by recommendations of how to manage and prevent adverse events associated with lenalidomide-based therapy.

Keywords: lenalidomide, multiple myeloma, immunomodulatory drugs, relapse treatment, refractory disease

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