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ASH 2025 | Favorable tolerability and early outcomes with full dose lenalidomide in older adults with NDMM
Othman Akhtar, MD, Medical College of Wisconsin, Milwaukee, WI, discusses an investigation into the optimal lenalidomide dosing strategy for older adults with newly diagnosed multiple myeloma (NDMM). This analysis showed that the majority of patients over 70 years old receiving lenalidomide-containing triplet or quadruplet induction regimens tolerated the recommended starting dose of 25 milligrams (mg) well, with low treatment-related discontinuations and dose modifications. This interview took place at the 67th ASH Annual Meeting and Exposition, held in Orlando, FL.
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Transcript
Yeah, I mean, one of the important questions that we get in the clinical setting is when we’re seeing these older patients who are over the age of 70, they’re receiving now three-drug and four-drug regimens. I think one of the questions we always have is, what is the lenalidomide dose that we should start patients on? And a lot of us are a bit gun-shy. We try to start patients at lower doses, worrying that they will not actually tolerate the full dose...
Yeah, I mean, one of the important questions that we get in the clinical setting is when we’re seeing these older patients who are over the age of 70, they’re receiving now three-drug and four-drug regimens. I think one of the questions we always have is, what is the lenalidomide dose that we should start patients on? And a lot of us are a bit gun-shy. We try to start patients at lower doses, worrying that they will not actually tolerate the full dose. So what we wanted to do in this analysis is we wanted to take all the patients over the age of 70 who had received either a three-drug or a four-drug regimen. So data on RVD, VRD, and combinations like that. And we wanted to see what the lenalidomide dosing strategy was, how many patients got full dose, how many patients got a lower dose, and how many patients who got full dose actually tolerated that, right? And so we had about 110 patients in our database. And what we found is that about 85 to 90% of patients actually tolerated the full 25 milligram dose of lenalidomide really well. Treatment-related discontinuations were low. Just 5% of patients actually had to discontinue lenalidomide due to toxic effects. And only about 10% of patients actually needed dose modifications due to adverse events. And so these are very encouraging data, and they tell us that at least in a subset of patients who are older, it might be safe to just start patients on full-dose lenalidomide rather than start on a low dose and stay on a lower dose.
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