Expert Point of View: Joseph R. Mikhael, MD


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Joseph R. Mikhael, MD

These are exciting data from the head-to-head phase III comparison of MPT [melphalan, prednisone, and thalidomide (Thalomid)], a globally accepted standard of care, to the novel combination of lenalidomide/low-dose dexamethasone in newly diagnosed multiple myeloma patients ineligible for transplant,” said Joseph R. Mikhael, MD, Mayo Clinic, Scottsdale, Arizona. Dr. Mikhael moderated a press conference at the American Society of Hematology (ASH) meeting where these data were presented.

“The study has implications for our colleagues in Europe, where MPT is widely used as first-line therapy. It is also important for hematologists in the United States, where lenalidomide [Revlimid]/dexamethasone is used, but it is used less often in older patients who are not candidates for transplant. The study shows that continuous Rd [lenalidomide (Revlimid) plus low-dose dexamethasone] can be used to convert multiple myeloma to a more chronic stable condition, especially in older adults,” Dr. Mikhael said.

European Perspective

MPT and MVP (melphalan, bortezomib [Velcade], prednisone) are both standard of care in Europe, said Jesus F. San Miguel, MD, PhD, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain, who introduced the talk by Thierry Facon, MD, at the ASH Plenary Session.

“This study compared one of those standards [MPT] to continuous lenalidomide/low-dose dexamethasone, and patients were treated until progression. This is the largest registration trial ever conducted in multiple myeloma,” he continued.

About 20% of the patients had high-risk genetics. The study included the sickest patients and those with renal insufficiency, who are not usually enrolled in clinical trials, Dr. San Miguel continued. “This is close to a real-life population,” he said.

“The trial establishes continuous Rd as a convenient, effective, and tolerable standard of care for the older patient with myeloma,” Dr. San Miguel stated. ■

Disclosure: Dr. Facon is a member of the Board of Directors or advisory committee and the speakers bureau for Celgene. Drs. Mikhael and San Miguel reported no potential conflicts of interest. 


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First-line treatment of newly diagnosed multiple myeloma using the Rd regimen (continuous lenalidomide [Revlimid] plus low-dose dexamethasone) was superior to standard triplet treatment with MPT (melphalan, prednisone, and thalidomide [Thalomid]) for 72 weeks, according to initial results of the...

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