One of the most interesting and unexpected findings in this survey related to the use of corticosteroids as part of maintenance therapy. For patients receiving lenalidomide maintenance we found a split in corticosteroid use, with Dr Vij not using this strategy because he questions the rationale for adding the immunosuppressive effect of corticosteroids to an immunomodulatory agent and Dr Munshi adding corticosteroids to lenalidomide, citing a recent Italian trial that demonstrated a progression-free survival benefit with 50-mg prednisone administered 3 times a week, although he uses dexamethasone 10 to 20 mg weekly.

Benboubker L et al. Lenalidomide and dexamethasone in transplant-ineligible patients with myeloma. N Engl J Med 2014;371(10):906-17. Abstract

Palumbo A et al. A phase III study of ASCT vs cyclophosphamide-lenalidomide-dexamethasone and lenalidomide-prednisone maintenance vs lenalidomide alone in newly diagnosed myeloma patients. Proc ASH 2013;Abstract 763.