Lenalidomide plus dexamethasone vs. lenalidomide plus melphalan and prednisone: A retrospective study in newly diagnosed elderly myeloma

Background: The goal of this retrospective study was to compare the efficacy and toxicity of lenalidomide-dexamethasone (lendex) vs. melphalan-prednisone-lenalidomide (MPR) as upfront therapy for newly diagnosed elderly patients with myeloma. Methods: Data from 51 patients enrolled in an Italian phase III trial and treated with MPR were analyzed and compared with data from 38 patients, seen at the Mayo Clinic, treated with lendex and enrolled in phase IIIII trials. Results: On intention-to-treat analysis, time to progression (median: 24.7 vs. 27.5 months in MPR and lendex groups, respectively, P = 0.903), progression-free survival (median: 24.7 vs. 27.5 months in MPR and lendex groups, respectively, P = 0.926), and overall survival (2-yr overall survival: 86.2% in MPR vs. 89.1% in lendex, P = 0.730) were not significantly different between the two groups. Results were confirmed when the analysis was restricted to MPR and lendex matched pair mates. Hematologic grade 3-4 toxicities were more common with MPR (neutropenia: 66.7% vs. 21.1%, P < 0.001; thrombocytopenia: 31.4% vs. 2.6%, P < 0.001). Grade 3-4 gastrointestinal events (13.2% vs. 3.9%, P = 0.132), thrombotic events (13.2% vs. 5.9%, P = 0.279), and fatigue (10.5% vs. 3.9%, P = 0.395) were more common with lendex. Conclusions: Results show that both MPR and lendex are efficacious regimens for elderly patients with myeloma. Randomized trials are needed to confirm these results.