Aims:

Lenalidomide (LEN) is an immunomodulatory agent registered for use in Australia as a second line treatment in relapsed or refractory multiple myeloma (rrMM). PBS subsidy of lenalidomide was based on two randomised controlled trials (RCTs) which showed increased survival of LEN plus dexamethasone (DEX) compared to DEX (34.4 vs. 30.7 months, p=0.02). Patients in trials may be different to rrMM patients in the clinical setting and we do not know how well LEN works in this setting. We aimed to determine survival outcomes for LEN in rrMM patients.

Methods:

Data was extracted from an electronic prescribing system (Charm®) and pathology results for rrMM patients planned to start LEN between 01/09/2009 - 01/09/2013 at five large Queensland public hospitals. Descriptive statistical analyses including Kaplan-Meier curves were used to calculate overall survival (OS).

Results:

There were 137 LEN-containing protocols for rrMM planned, 2,234 LEN doses ordered and 136 patients who received at least one LEN dose.  The median age was 69 years and 55% were male. The patients were split into two LEN-containing protocol groups:  90% had LEN + DEX; 10% had LEN + DEX with cyclophosphamide based chemotherapy. The median LEN dose was 15mg (day 1-21) of a 28 day cycle. Median time on treatment was 279 days. Median overall survival from first dose of LEN was 45.4 months.

Conclusions:

The median survival was considerably longer than the survival reported in trials despite our patients being older and using lower LEN doses. These data provide reassurance that outcomes for rrMM patients treated at Queensland public hospitals are at least as good as those observed in trials.