We asked about the usual dose of lenalidomide in the maintenance setting for older patients, and although the faculty and most oncologists used 10 or 15 mg, again, about a quarter would use a higher dose. Dr Munshi is concerned about the higher baseline risk of myelodysplastic syndromes in older patients, particularly because patients with myeloma are at greater baseline risk, and he carefully monitors blood counts and discontinues lenalidomide at the first sign of any cytopenias.

Palumbo A et al. Management of older adults with multiple myeloma. Blood Rev 2013;27(3):133-42. Abstract

McCarthy P et al. Lenalidomide after stem-cell transplantation for multiple myeloma. N Engl J Med 2012;366(19):1770-81. Abstract

Attal M et al. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N Engl J Med 2012;366(19):1782-91. Abstract