High-dose dexamethasone is a mainstay of therapy for multiple myeloma. However, a study published today online and in the November edition of The Lancet Oncology concludes that lenalidomide plus low-dose dexamethasone is associated with better short-term overall survival and lower toxicity than lenalidomide plus high-dose dexamethasone in patients with newly diagnosed myeloma; and is thus a viable treatment option for these patients.
“High-dose dexamethasone in a community-setting seems more toxic than low-dose dexamethasone, with more early deaths in the first 4 months, increased risk of thromboembolic complications, and higher overall risk of serious adverse
events, particularly in patients older than 65 years,” said S. Vincent Rajkumar, M.D., consultant, hematology, Mayo Clinic, and the lead author on the study.
The researchers found that 79% of 214 patients receiving high-dose therapy and 68% of 205 patients on low-dose therapy had complete or partial response within four cycles. However, at the second interim analysis at 1 year, overall survival was 96% in the low-dose dexamethasone group compared with 87% in the high dose group. As a result, the trial was stopped and patients on high dose therapy were crossed over to low-dose therapy. 117 (52%) patients on the high-dose regimen had grade 3 or worse toxic effects in the first 4 months, compared with 35% of the 220 on the low-dose regimen for whom toxicity data were available. Preliminary findings of this study were previously reported in abstract form at American Society of Hematology’s annual meeting in December 2007.
For interviews with Dr. Rajkumar, contact Mayo Clinic’s Karl Oestreich or Amy Tieder at 507-284-5005.
