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Open Journal of Hematology

ISSN: 2075-907X
Volume 8, 2017

Indexed in:

Open Journal of Hematology, 2014, 5-9 [Research Article]

Dose-adjustment of lenalidomide according to patient age and vulnerability is feasible in relapsed or refractory multiple myeloma: retrospective analysis of 20 cases

Shigeki Ito, Maki Asahi, Tadashi Shimoyama, Yuzo Suzuki, Ryousei Sasaki, Yoshiaki Okano, Yukiteru Fujishima, Yusei Aoki, Shugo Kowata, Tatsuo Oyake, Yoji Ishida

Hematology & Oncology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Iwate, Japan

Corresponding Author & Address:

Shigeki Ito*
Hematology & Oncology, Department of Internal Medicine, Iwate Medical University School of Medicine 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan; Phone: 81-19651-5111; Fax: 81-19651-5185; Email: shigei@iwate-med.ac.jp

Article History:
Published: 27th October, 2014   Accepted: 27th October, 2014
Received: 10th September, 2014  

© Ito et al.; licensee Ross Science Publishers

ROSS Open Access articles will be distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided that the original work will always be cited properly.

Keywords: lenalidomide, multiple myeloma, dose adjustment, vulnerability, frailty


The European Myeloma Network (EMN) has recently proposed an algorithm for the optimal starting dose and dose modification of antimyeloma drugs for elderly or unfit patients with multiple myeloma. However, the feasibility of this algorithm remains unclear. Therefore, we retrospectively assessed the feasibility of lenalidomide therapy for 20 patients with relapsed or refractory multiple myeloma (RRMM). We divided the patients into two groups, the recommended dose (RD) group (n = 12) in which the administered dose corresponded to the recommended dose according to the EMN algorithm, and the non-recommended dose (NRD) group (n = 8) in which the administered dose did not correspond to the recommended dose and we compared the efficacy and toxicity of lenalidomide therapy between the two groups. The overall response rate was 67% and 63% in the RD and NRD groups, respectively. There was no significant difference in time to progression between the two groups (9 vs. 14 months P = 0.75). Grade 3/4 neutropenia and grade 2/3 fatigue were less frequent in the RD group than in the NRD group (50% vs. 88% and 8% vs. 38%, respectively). The discontinuation rate due to severe adverse events was much lower in the RD group than in the NRD group (17% vs. 50%). These results indicated that the dose adjustment strategy of lenalidomide according to the algorithm may maintain efficacy and improve the safety profile in patients with RRMM. From our results, the algorithm seemed to be feasible for elderly or unfit myeloma patients in daily practice. A larger prospective study is needed to confirm the feasibility of this algorithm.

©2017 Ross Science Publishers