The overall risk of second primary malignancies (SPMs) is low and should therefore not impact the current therapeutic decision-making process in patients with multiple myeloma, according to a study published in the journal Annals of Oncology.1

Therapeutic advancements have significantly improved clinical outcomes for patients with multiple myeloma, but increased life expectancy has led to concerns about the long-term risk of SPMs. Therefore, a panel of International Myeloma Working Group members sought to review current data on the potential host-, disease-, and treatment-related risk factors associated with the development of SPMs in patients with multiple myeloma and provide practical recommendations to assist clinicians in treatment decision-making.

Investigators found that the risk of SPMs overall in patients with multiple myeloma is low. In addition, that risk is associated with multiple factors and is partially related to the length of patients’ survival.

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The literature review showed that lenalidomide administered after, or concurrently with, oral melphalan is significantly associated with increased incidence of SPMs. The panel also found associations between lenalidomide maintenance following high-dose melphalan and increased SPM incidence, but to a lesser extent.

Results showed that the risk of multiple myeloma-related death was significantly higher than the risk of death from SPMs in both cases, with lenalidomide possibly providing a survival benefit.

There was no association between lenalidomide plus dexamethasone, or a regimen containing bortezomib and oral melphalan, dexamethasone, or thalidomide, and an increased risk of SPMs.

The findings ultimately suggest that regimens such as lenalidomide plus dexamethasone should be preferred to prolonged exposure to lenalidomide plus melphalan in order to reduce the risk of SPMs in this era of novel agents and improved survival.


1. Musto P, Anderson KC, Attal M, et al. Second primary malignancies in multiple myeloma: an overview and IMWG consensus. Ann Oncol. 2016 Nov 17. doi: 10.1093/annonc/mdw606. [Epub ahead of print]