%0 Journal Article
%T Practical Approaches to the Use of Lenalidomide in Multiple Myeloma: A Canadian Consensus
%A Donna Reece
%A C. Tom Kouroukis
%A Richard LeBlanc
%A Michael Sebag
%A Kevin Song
%A John Ashkenas
%J Advances in Hematology
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/621958
%X In Canada, lenalidomide combined with dexamethasone (Len/Dex) is approved for use in relapsed or refractory multiple myeloma (RRMM). Our expert panel sought to provide an up-to-date practical guide on the use of lenalidomide in the managing RRMM within the Canadian clinical setting, including management of common adverse events (AEs). The panel concluded that safe, effective administration of Len/Dex treatment involves the following steps: (1) lenalidomide dose adjustment based on creatinine clearance and the extent of neutropenia or thrombocytopenia, (2) dexamethasone administered at 20¨C40£¿mg/week, and (3) continuation of treatment until disease progression or until toxicity persists despite dose reduction. Based on available evidence, the following precautions should reduce the risk of common Len/Dex AEs: (1) all patients treated with Len/Dex should receive thromboprophylaxis, (2) erythropoiesis-stimulating agents (ESAs) should be used cautiously, and (3) females of child-bearing potential and males in contact with such females must use multiple contraception methods. Finally, while Len/Dex can be administered irrespective of prior therapy and in all prognostic subsets, patients with chromosomal deletion 17(p13) have less favorable outcomes with all treatments, including Len/Dex. New directions for the use of lenalidomide in RRMM are also considered. 1. Introduction Multiple myeloma (MM), the second most common hematological malignancy in adults, is associated with various clinical manifestations including anemia, lytic bone lesions, and renal and immune impairments. According to Canadian Cancer statistics, an estimated 2300 Canadians will be diagnosed with MM and 1350 will die from this disease in 2011 [1]. While no cure for MM is available, five-year survival rates have risen substantially in Canada and elsewhere over the last decade, partly due to novel therapies such as thalidomide, bortezomib, and lenalidomide [2, 3]. Nonetheless, regardless of initial treatment, most patients will eventually relapse and require salvage therapy, often consisting of novel agents, alone or in combination. Lenalidomide is an immunomodulatory drug with direct effects on myeloma cells as well as their microenvironment. Early clinical trials with lenalidomide as a single agent in relapsed or refractory MM (RRMM) patients demonstrated its antimyeloma activity [4]. In preclinical studies, the agent has been shown to kill myeloma cells by upregulating certain cyclin-dependent kinase inhibitors and other early response factors [5]. Lenalidomide can also induce apoptosis by
%U http://www.hindawi.com/journals/ah/2012/621958/