Lenalidomide + Dexamethasone continuous (Rd, MAIA control arm — MM 1L transplant-ineligible)
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
Knowledge-base record for audit. Provisional clinical content: this is not a prescription. An oncologist must verify original sources, applicability and review status. Full rules and constraints are in the YAML.
| Components | DRUG-LENALIDOMIDE DRUG-DEXAMETHASONE |
|---|
| ID | REG-RD-CONTINUOUS |
|---|---|
| Type | Regimen |
| Status | reviewed 2026-05-09 | pending_clinical_signoff |
| Diseases | None declared |
| Sources | SRC-MAIA-FACON-2019 SRC-NCCN-MM-2025 |
Notes
Rd continuous (lenalidomide + low-dose dexamethasone until progression) was the MAIA control arm (Facon NEJM 2019, PMID 30926586) and represents the standard-access first-line regimen for transplant-ineligible NDMM. MAIA control arm outcomes: ORR 75.8%, PFS HR (D-Rd vs Rd) 0.56 (95% CI 0.43–0.73), 30-month PFS ~53.3% for D-Rd vs ~37.8% for Rd. Rd continuous showed superiority over MPT and melphalan-prednisone in the FIRST trial (Benboubker NEJM 2014, PMID 25184863): PFS 26 months vs 21.9 months for MPT. Dose of dexamethasone: low-dose (40 mg weekly = "Ld schedule") is preferred over high-dose (480 mg/cycle); ECOG E4A03 showed equivalent efficacy and better tolerability with low-dose dex in NDMM (Rajkumar LANCET ONCOL 2010). Renal adjustment is critical: lenalidomide is ~80% renally cleared. CrCl 30-60 → 10 mg daily; CrCl <30 → 5 mg daily or 10 mg qod. Myeloma renal impairment often improves with therapy — recheck CrCl monthly and escalate dose when GFR recovers. Second primary malignancy (SPM) risk: CALGB 100104 and IFM 2005-02 documented elevated SPM (MDS/AML) with lenalidomide maintenance post-ASCT; risk applies to continuous Rd as well at smaller magnitude. Must be included in...
Used By
Indication
IND-MM-1L-RD- IND-MM-1L-RD