Researchers from Italy have reported that the combination of Revlimid® (lenalidomide), melphalan, prednisone, and Thalomid® (thalidomide) results in a 76% response rate in patients with relapsed or refractory multiple myeloma. The details of this study were presented on December 9 at the 2008 meeting of the American Society of Hematology.[1]

Revlimid, Thalomid and Velcade® (bortezomib) have had a major impact on treating relapsed and newly diagnosed patients with multiple myeloma. Researchers are still evaluating the optimal way to incorporate these new agents into the most effective treatment regimens.

The current study combined Revlimid, melphalan, prednisone, and Thalidomid for the treatment of 44 patients with relapsed or refractory myeloma. Patients were randomly allocated to receive 50 or 100 mg per day of Thalomid. Aspirin was also administered as prophylaxis of thromboembolic complications, which are increased with the use of Revlimid and Thalomid. Twenty-six of the 44 patients received this regimen as second-line therapy and 18 as third-line therapy. Twenty patients had received a previous autologous stem cell transplant, and three had received an allogeneic stem cell transplant. Nine patients had failed a Velcade-based regimen. The overall response rate was 76%, with 30% achieving a very good partial response. The very good partial response rate was 36% in patients receiving second-line therapy. The overall response rate was higher for patients receiving 100 mg per day of Thalomid: 93% versus 65%. The one-year progression-free survival was 49% with an overall survival of 90%. There were no thromboembolic side effects observed.

Comments: These are very high response rates for relapsed patients with multiple myeloma. However, it is not clear that using more agents in a single regimen for treatment of relapsed myeloma will improve survival over sequential use of the same agents.

Reference:

[1] Palumbo A, Falco P, Sanpaolo G, et al. Combination of lenalidomide, melphalan, prednisone and thalidomide (RMPT) in relapsed/refractory multiple myeloma: Results of a multicenter phase II clinical trial. Blood. 2008;112:321m abstract number 868.