Extinguishing The Fire Before The Flame: Early Treatment For High Risk Smouldering Multiple Myeloma


For patients with smouldering multiple myeloma, the standard of care is observation until symptoms develop. However, this approach does not identify high-risk patients who may benefit from early intervention.

In this phase 3 trial, patients with high-risk smouldering multiple myeloma (SMM) where given a combination of lenalidomide and dexamethasone and compared to patients that where not treated.

After a follow-up of 40 months, the median progression free survival (PFS) rate had not been reached in the lenalidomide and dexamethasone group, compared to only 21 months for the non-treated group. The hazard ratio (HR) for progression was 0.18; 95% confidence interval [CI], 0.09 to 0.32; P<0.001). In other words, this treatment reduced the risk of disease by 82%!

Furthermore, after 3 years, 94% of the patients taking lenalidomide and dexamethasone were still alive compared with 80% for the non-treated group. The hazard ratio for death was 0.31; 95% CI, 0.10 to 0.91; P=0.03), or a 69% reduction in the risk of dying from the disease.

A partial response or better was achieved in 79% of patients in the treatment group after the induction phase and in 90% during the maintenance phase. Toxic effects were mainly grade 2 or lower.

I like this approach because it clearly shows how early treatment for patients with high-risk smouldering myeloma delays progression to active disease and increases overall survival without significant toxic side effects.

Lenalidomide plus Dexamethasone for High-Risk Smouldering Multiple Myeloma

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