Hematologists should weigh the risks and benefits carefully when considering lenalidomide (Revlimid) or other maintenance therapy for their patients with myeloma, according to William I. Bensinger, MD, of the Fred Hutchinson Cancer Research Center, Seattle.

Lenalidomide is associated with considerable adverse effects that require closer monitoring, and the drug is expensive, costing about $80,000 per year.

“While improved progression-free survival is [desirable], if the overall survival is no different and you can use this drug at relapse for a shorter period of time, what’s the benefit [of maintenance]?” he asked.

Longer Follow-up Needed

It will require longer follow-up to determine whether second primaries will become even more common with time. Tangentially, the lenalidomide data have raised concerns about use of thalidomide (Thalomid) concurrently or sequentially with melphalan as well.

“I’m much more cautious about recommending maintenance to my patients,” Dr. Bensinger concluded. “If there’s a clinical trial that looks useful, then it’s worth enrolling them. But off of a clinical trial, I tend to be much more conservative about maintenance therapy.” ■