How long should a multiple myeloma patient receive lenalidomide maintenance therapy?

Here’s how readers responded to a You Make the Call question about lenalidomide maintenance in a patient with multiple myeloma.

Disclaimer: ASH does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this article is solely at your own risk.

I think it would be very useful to assess minimal residual disease (MRD).

Hervé Avet Loiseau, MD, PhD
Institut Universitaire du Cancer
Toulouse, France

I would continue lenalidomide until disease progression. I would consider discontinuing lenalidomide if there was no evidence of MRD by next-generation sequencing.

Juan M. Alcantar, MD
UCLA Health
Los Angeles, California

I would stop lenalidomide, because the patient has been in complete remission for 12 years (since 2004).

Gilberto de Freitas Colli
Hospital de Câncer de Barretos
São Paulo, Brazil

I would be reluctant to stop lenalidomide as long as the patient had no major adverse effects.

Phillip Periman, MD
Texas Oncology-Amarillo Cancer Center
Amarillo, Texas

I would continue lenalidomide if there are no toxicity issues.

Antoine Sayegh, MD
Kaiser Permanente Medical Center
Roseville, California

I would suggest performing a FDG-PET scan (higher sensitivity than M-C assay).

Prof. Andrea Gallamini
Lacassagne Cancer Centre
Nice, France

Stop the lenalidomide. He has already demonstrated that his disease is not aggressive (19 years) and responded to several treatments. Monitor him when the disease progresses, then treat.

Paul Chervenick, MD
H. Lee Moffitt Cancer Center & Research Institute
Tampa, Florida

I would stop the lenalidomide and monitor his M protein. Restart when there is unequivocal progression.

David Baer, MD
Kaiser Permanente Oakland/Richmond Medical Center
Oakland, California

I would continue lenalidomide if well tolerated until progression, despite complete response clinically. In addition to free kappa/lambda ratio, SPEP, and UPEP, I follow patients with yearly PET/CT. In my opinion, this is better than bone survey.

William Caceres
Universidad Central del Caribe School of Medicine
San Juan, Puerto Rico

I would discontinue lenalidomide, but I would try to harvest CD34+ cells. If he relapses, I would go for a second autologous transplant in early relapse.

Eduardo E. Reynoso, MD
Hospital Espanol de Mexico
Polanco, Mexico

I would continue lenalidomide to keep the malignant clone suppressed.

Ken Romeril, MBChB
Wellington Blood and Cancer Centre
Wellington, New Zealand

I would favor stopping lenalidomide. There is concern about long-term carcinogenic effect. Follow parameters closely, and resume therapy at earliest sign of recurrence.

Glenn J. Shamdas, MD
Fargo Veterans Affairs Health Care System
Fargo, North Dakota

I would continue the drug until relapse, assuming no significant toxicity develops.

Edwin C. Kingsley, MD
Comprehensive Cancer Centers of Nevada
Las Vegas, Nevada

We would stop lenalidomide and follow him regularly (every 2 months) with serum protein electrophoresis and free light chain assay.

Rayaz Ahmed, MD
Rajiv Gandhi Cancer Institute & Research Centre
New Delhi, India

If the tolerability is good and there is no specific contraindication, then continue until disease progression.

Naeem A. Chaudhri, MD
King Faisal Specialist Hospital & Research Centre
Saudi Arabia

I would continue for five years unless financial constraints and/or adverse effects appear.

John Hanson, MD
Milwaukee, Wisconsin

I would evaluate patient for MRD. If negative, I would discontinue lenalidomide.

Anastasios Raptis, MD
UPMC Cancer Center
Pittsburgh, Pennsylvania

I think after three years of lenalidomide-maintenance and getting a complete response, if negative, it is a good idea to stop therapy.

Franz Bauer
Universitätsklinik für Innere Medizin I