Lenalidomide Treatment for Multiple Myeloma: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND: In recent years, a number of randomized controlled trials (RCTs) have reported on lenalidomide as a treatment for multiple myeloma (MM). Herein, we report results of a meta-analysis of RCTs examining the efficacy and safety of lenalidomide for MM. PATIENTS AND METHODS: Databases were searched using the terms “lenalidomide or revlimid AND multiple myeloma.”RCTs evaluating initial or maintenance therapeutic outcomes were included. Main outcome measures were response rates, progression-free survival (PFS), overall survival, and adverse events. RESULTS: Seven trials were included (N = 192–614 participants). Lenalidomide doses and treatment regimens differed between trials. Complete response (CR) and very good partial response (VGPR) risk ratios (RR) favored lenalidomide over placebo (CR = 2.54, 95% confidence interval [CI] = 1.29–5.02; VGPR = 2.82, 95% CI = 1.30–6.09). The PFS hazard ratio favored lenalidomide over placebo (0.37, 95% CI = 0.33–0.41). For adverse events, neutropenia, deep vein thrombosis (DVT), infection, and hematologic cancer RR favored placebo over lenalidomide (neutropenia: 4.74, 95% CI = 2.96–7.57; DVT: 2.52; 95% CI: 1.60–3.98; infection: 1.98; 95% CI: 1.50–2.62; hematologic cancer: 3.20; 95% CI: 1.28–7.98). CONCLUSIONS: Lenalidomide is an effective treatment for MM; however, treatment-related adverse events must be considered and appropriate adjustments and/or prophylactic treatment should be initiated where possible.