Outcomes of Lenalidomide Relapsed/Refractory Patients

Authors: Gkioka AI , Gkiokas A , Oikonomou G , Koudouna A , Bartzi V , Nikolaou E , Panayiotidis P and Kyrtsonis MC

DOI: 10.23880/hij-16000274

Volume 10, Issue 1

Abstract

Lenalidomide constitutes a key component of therapeutic strategies for multiple myeloma (MM), both in combination with dexamethasone and as maintenance treatment. However, patients exhibit substantial heterogeneity in response and duration of benefit. In order to focus only on the benefit of Lenalidomide, we retrospectively analyzed 186 MM patients treated with doublet, lenalidomide–dexamethasone (n=158) and lenalidomide maintenance post-ASCT (n=18). Patients were stratified into five groups based on time to progression: primary refractory (PRMM), very resistant (VRMM), resistant (ResMM), initially sensitive (ISMM), and long-lasting responders (RALR). Median overall survival after lenalidomide (LenOS) varied markedly: PRMM 2 months, VRMM 8 months, ResMM 12 months, ISMM 39 months, and RALR 106 months (p<0.0001). PRMM and VRMM patients had poor salvage responses, whereas ISMM and RALR maintained prolonged disease control and benefited from multiple subsequent therapies. Lenalidomide maintenance yielded a median time to relapse of 28 months, with rare early resistance. No clinical baseline features correlated with ResMM, ISMM, or RALR, suggesting conventional markers are insufficient to capture lenalidomide resistance later. These findings highlight the prognostic relevance of relapse timing, inform therapeutic sequencing, and emphasize the need for prospective studies incorporating genomic and immunologic biomarkers to refine individualized MM management.

Keywords: Multiple Myeloma; Lenalidomide Refractoriness; iMiDs; Relapse/Refractory; Overall Survival

View PDF