Triple therapy with melphalan, prednisone and thalidomide (MPT) is the current standard of care for patients with myeloma who are ineligible for stem-cell transplantation.
This may change following publication in The
New England Journal of Medicine (online, 4 September 2014)
of data on a promising new combination therapy, lenalidomide plus dexamethasone (LD).
The “FIRST” trial included 1,623 patients newly diagnosed with multiple myeloma and ineligible for stem-cell therapy. At a median follow-up of 37 months, progression-free survival was 25.5 months with continuous LD, 20.7 months with 18 cycles of LD and 21.2 months with MPT. Continuous LD was superior to MPT for all secondary efficacy endpoints, including overall survival, and was associated with a lower frequency of grade 3 or 4 adverse events.
 Benboubker L, Dimopoulos MA, Dispenzieri A et al. Lenalidomide and Dexamethasone in Transplant-Ineligible Patients with Myeloma. The New England Journal of Medicine (2014;371:906-917) doi: 10.1056/NEJMoa1402551.