Combining lenalidomide with low-dose rather than high-dose dexamethasone for the treatment of multiple myeloma improves survival and lowers toxicity, according to the results of a controlled trial. A total of 445 patients with multiple myeloma were randomised to lenalidomide plus dexamethasone at either high dose (maximum 480mg) or low dose (maximum 160mg). At one year, overall survival was 96 per cent in the low-dose group, compared with 87 per cent in the high-dose group (p = 0.0002). Just over half of those on the high-dose regimen had grade three or worse toxic effects in the first four months, compared with 35 per cent of patients on the low-dose regimen (p = 0.0001).

Rajkumar SV, Jacobus S, Callander NS et al. Lancet Oncol 2009;doi:10.1016/S1470-2045(09)70284-0

Originally published in the December 2009 edition of MIMS Oncology & Palliative Care.

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