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Decision 2

Decision 2

Case description: Mindy, a 76-year-old patient with MM, returns for an oncology consultation at 12 months after initiation of DRd. She is considered ineligible for autologous stem cell transplantation. Mindy achieved PR at month 1, VGPR at month 6, and complete response (CR) at month 12. She has continued treatment with DRd, with a lenalidomide dose reduction (from 25 mg to 15 mg daily) at month 9.

  • Comorbidities: Parkinson’s disease remains well controlled with medication and her daily functioning is consistent with baseline (ECOG performance status I).
  • Current presentation: Chemistry and hematology values remain stable, reflecting CR. Neutropenia resolved after a lenalidomide dose reduction. No new findings have been detected on imaging tests.
  • Challenge: Mindy’s children share that the patient is getting tired of the medication burden associated with the treatment of MM and Parkinson’s disease, and has decreased adherence (75%) to lenalidomide (15 mg daily). They ask about the possibility of stopping MM treatment and resuming therapy if Mindy experiences a relapse, or finding alternatives to reduce the medication burden.

Choose your next step:

References:

1. Nakaya A, Fujita S, Satake A, Nakanishi T, Azuma Y, Tsubokura Y, et al. Realistic Lenalidomide Dose Adjustment Strategy for Transplant-Ineligible Elderly Patients with Relapsed/Refractory Multiple Myeloma: Japanese Real-World Experience. Acta Haematol 2017; 138:55-60

2. Facon T, Kumar S, Plesner T, Orlowski RZ, Moreau P, Bahlis N, et al, MAIA Trial Investigators. Daratumumab plus Lenalidomide and Dexamethasone for Untreated Myeloma. N Engl J Med 2019; 380:2104-2115.

3. Lipe B, Vukas R, Mikhael J. The role of maintenance therapy in multiple myeloma. Blood Cancer J 2016; 6:e485.

4. Rosiñol L, Oriol A, Ríos R, Blanchard MJ, Jarque I, Bargay J, et al. Lenalidomide and dexamethasone maintenance with or without ixazomib, tailored by residual disease status in myeloma. Blood 2023; 142:1518-1528.

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with Dr. Andrew Yee

Decision 2 Analysis

with Dr. Andrew Yee

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