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Advances in Hematology
Volume 2012 (2012), Article ID 621958, 14 pages
doi:10.1155/2012/621958
Practical Approaches to the Use of Lenalidomide in Multiple Myeloma: A Canadian Consensus
1Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
2Department of Oncology, Juravinski Cancer Centre, 699 Concession Street, Hamilton, ON, L8V 5C2, Canada
3Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, QC, H1T 2M4, Canada
4McGill University Health Centre, McGill University, Montreal, QC, H3A 1A1, Canada
5Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, BC, V5Z 1M9, Canada
6SCRIPT, Toronto, ON, M4S 1Z9, Canada
Received 5 April 2012; Accepted 14 August 2012
Academic Editor: Antonio Palumbo
Copyright © 2012 Donna Reece et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
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 20–40 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.