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Lenalidomide + Dexamethasone continuous (Rd, MAIA control arm — MM 1L transplant-ineligible)

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Fonte YAML: registo completo

Notas

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...

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Indicação

• IND-MM-1L-RD - IND-MM-1L-RD