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Blood, 15 November 2006, Vol. 108, No. 10, pp. 3458-3464.
Prepublished online as a Blood First Edition Paper on July 18, 2006July 13, 2006; DOI 10.1182/blood-2006-04-015909.


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Submitted April 13, 2006
Accepted May 22, 2006

A randomized phase 2 study of lenalidomide therapy for patients with relapsed or relapsed and refractory multiple myeloma

Paul G Richardson*, Emily Blood, Constantine S Mitsiades, Sundar Jagannath, Steven R Zeldenrust, Melissa Alsina, Robert L Schlossman, S V Rajkumar, K R Desikan, Teru Hideshima, Nikhil C Munshi, Kathleen Kelly-Colson, Deborah Doss, Mary L McKenney, Svetlana Gorelik, Diane Warren, Andrea Freeman, Rebecca Rich, A. Wu, M Olesnyckyj, K Wride, William S Dalton, Jerome Zeldis, Robert Knight, Edie Weller, and Kenneth C Anderson

Dana Farber Cancer Institute, Boston, MA
Dana-Farber Cancer Institute, Harvard Med. School
St Vincent's Comprehensive Cancer Center, NY
Mayo Clinic, Rochester, MN
H.Lee Moffitt Cancer Center, Tampa, FL
St Vincent's Comprehensive Cancer Center, NY, NY;
Dana-Farber Cancer Institute, Boston, MA
Celgene Corp. Summit, NJ
H. Lee Moffitt Cancer Center

* Corresponding author; email: paul_richardson{at}dfci.harvard.edu.

This multi-center, open-label, randomized phase 2 study evaluated 2 dose regimens of lenalidomide for relapsed, refractory myeloma. Seventy patients were randomized to receive either 30 mg once-daily or 15 mg twice-daily oral lenalidomide for 21 of every 28-day cycle. Patients with progressive or stable disease after two cycles received dexamethasone. Analysis of the first 70 patients showed increased grade 3-4 myelosuppression in patients receiving 15 mg twice-daily (41% versus 13%, p=0.03). An additional 32 patients received 30 mg once- daily. Responses were evaluated according to EBMT criteria. Overall response rate (complete, partial or minor) to lenalidomide alone was 25% (24% for once-daily and 28% for twice-daily lenalidomide, respectively). Median overall survival in 30 mg once-daily and twice- daily groups was 31 and 27 months. Median progression- free survival was 7.7 months on once-daily vs 3.9 months on twice-daily lenalidomide (p=0.2). Dexamethasone was added in 68 patients and 29% responded. Time to first occurrence of grade 3-4 myelosuppression was shorter in the twice-daily group (1.8 vs 5.5 months, p=0.05). Significant peripheral neuropathy and deep vein thrombosis each occurred in only 3%. Lenalidomide is active and well tolerated in relapsed, refractory myeloma. The 30 mg once-daily regimen provides the basis for future studies as monotherapy and with dexamethasone.


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