I do not recommend corticosteroids with lenalidomide maintenance therapy.

If I propose single-agent lenalidomide maintenance, I do not typically administer steroids.

We usually do not use steroids with lenalidomide maintenance. One study by Palumbo and colleagues compared maintenance therapy with lenalidomide/prednisone to lenalidomide alone for patients with newly diagnosed MM. The addition of prednisone to lenalidomide significantly increased progression-free survival. However, no difference was observed in overall survival.

I am not convinced yet, mostly because of tolerability issues in the transplant setting. I’d like to see a little more data on it.

I typically don’t administer corticosteroids with maintenance therapy. The exception is if I’m using a consolidation approach and administering more intense therapy, in which case I would include dexamethasone.

I do not recommend maintenance therapy because it has not been approved in France.

I would not suggest the addition of corticosteroids to lenalidomide maintenance therapy. We have a couple of ongoing randomized studies in which we are comparing the efficacy of lenalidomide to lenalidomide with corticosteroids. The preliminary data suggest that corticosteroids may be beneficial, but toxicity is increased and it is too early to put into practice.

I generally don’t administer corticosteroids for patients who are receiving lenalidomide maintenance therapy. I will sometimes administer them if I am using bortezomib because I feel it helps with tolerability, but I don’t use corticosteroids if I am using maintenance with single-agent lenalidomide.

I use lenalidomide alone for tolerability reasons. I don’t believe steroids are well tolerated when administered after transplant. They have long-term effects that are challenging. I recommend corticosteroids with bortezomib maintenance for the purpose of minimizing side effects.