Medical Information

Lenalidomide has shown significant efficacy in hematological tumors such as multiple myeloma, but strict adherence to discontinuation guidelines and precautions is necessary. The following provides a detailed explanation from three aspects: treatment effectiveness, discontinuation plan, and precautions.

1. Therapeutic effect

(1) Multiple myeloma

In the combination of dexamethasone regimen, the median progression free survival can reach 14-20 months, the overall response rate is 60-70%, and the complete remission rate is about 15-20%.

(2) Myelodysplastic syndrome

The improvement rate of transfusion independence in 5q deficient patients was 67%, the cytogenetic remission rate was 45%, and the median duration of efficacy was 2.2 years.

(3) Mantle cell lymphoma

The objective remission rate of recurrent/refractory patients is 28%, with a median progression free survival of 4 months, and some patients can achieve long-term disease control.

2. Discontinuation plan

(1) Disease progression and discontinuation of medication

After confirming imaging or laboratory progress, treatment should be terminated, and safety assessment and protocol conversion should be completed within 2 weeks.

(2) Adverse reactions: discontinuation of medication

Suspend medication when grade 4 hematological toxicity or grade 3 non hematological toxicity occurs, reduce dosage by 25-50% after recovery to ≤ grade 2, and restart.

(3) Planned discontinuation of medication

For patients who have maintained treatment for at least 2 years and have sustained complete remission, it may be considered to gradually reduce the dosage (by 25% every 3 months) until discontinuation.

3. Precautions

(1) Thrombosis prevention

All patients need to receive aspirin or low molecular weight heparin for prevention, especially when combined with dexamethasone, which increases the risk by 3-4 times.

(2) Blood monitoring

Blood routine tests will be conducted weekly in the first month of treatment, followed by monthly monitoring. If the neutrophil count is less than 500/mm ³, medication should be stopped immediately.

(3) Pregnancy taboos

After discontinuing the medication, contraception is still required for 3 months (male patients) to 4 weeks (female patients), and two negative pregnancy tests are required for confirmation.

(4) Liver function management

If the transaminase level is greater than 5 times the normal value, permanent discontinuation of medication is required. For mild to moderate injuries, the dosage should be reduced by 50% and liver function should be monitored weekly.