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Advances in Hematology
Volume 2012 (2012), Article ID 621958, 14 pages
http://dx.doi.org/10.1155/2012/621958
Review Article

Practical Approaches to the Use of Lenalidomide in Multiple Myeloma: A Canadian Consensus

1Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto, ON, Canada M5G 2M9
2Department of Oncology, Juravinski Cancer Centre, 699 Concession Street, Hamilton, ON, Canada L8V 5C2
3Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, QC, Canada H1T 2M4
4McGill University Health Centre, McGill University, Montreal, QC, Canada H3A 1A1
5Leukemia/BMT Program of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada V5Z 1M9
6SCRIPT, Toronto, ON, Canada M4S 1Z9

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.