Whethe ANC ncreases to 1000 per L and neutrope na s the only toxcty, lenaldomde must be resumed at 25 mg day or at 15 mg day f there s one other toxcty.For each subsequent fall to one thousand per L, treatment method must agabe nterrupted and resumed at 5 mg significantly less thathe prevous dose whethe ANC recovers to over here one thousand per L.For other grade three or four toxctes linked to lenaldomde, treatment method need to be nterrupted and restarted in the up coming lower dose level whethe toxctyhas resolved to grade 2 or reduced.Lenaldomde should really not be dosed under five mg day.138 Place therapy patents wth relapsed or refractory MM whohave receved 1 three pror lnes of treatment, lenaldomde combnatowthhgh dose dexamethasone generates sgnfcant prolongatoof TTand OS compared wthhgh dose dexamethasone alone.
2,three patents wth prevously untreated MM, lenaldomde combnatowth lower dose dexametha sone generates a sgnfcant survval advantage in contrast wth lenaldomde plushgh dose dexamethasone.84,90 the two the newly dagnosed and relapsed or refractory settngs, the addtoof lenaldomde tohgh dose dexamethasone s assocated wth ahgher charge of grade 3 or four myelosuppres son, and also the absence of approprate additional info thromboprophylaxs, ahgher price of VTE occasions compared wthhgh dose dexa methasone alone.two,three,43,139however, there s degree 2 evdence from your MM 009 review that survval s not impacted by occurrence of DVT.126 The MM 009 and MM 010 pvotal phase studes provded level two evdence assistance of lenaldomde plus dexamethasone the relapsed or refractory settng.Just after a medafollow uof 17.1 months post randomzaton, medaOS the lenaldomde plushgh dose dexametha sone grouwas 29.
6 months MM 009 and notet reached MM 010.2,3 comparson, medaOS the placebo plushgh dose dexamethasone grouwas twenty.two months MM 009 and 20.6 months

MM 010.Consequently, the addtoof lenaldomde tohgh dose dexamethasone patents whohave receved one 3 pror therapes s lkely to prolong medasurvval by approxmately nne months.Following adjustng for crossover of patents ntally assgned to dexamethasone alone nto the lenaldomde arm, prolongatoof survval s lkely to get additional enhanced.124 Level two evdence s avaable support of ths regmepatents wth one particular or more thaone pror lnes of therapy,100 patents wth or wthout prev ous thaldomde exposure,99 patents wth or wthout pror autologous SCT,137 and patents wth md to reasonable renal mparment.104 Additionally, there s degree 2 evdence help of ths regmepatents aged 65ears and individuals aged 65ears.136 There s level 2 evdence support of lenaldomde plus dexamethasone patents wth newly dagnosed MM from two phase studes.83,84,90,91 one particular research, the nvestgators dd not drectly assess the lenaldomde primarily based regmewth a recognzed therapy.84,90 nstead, patents just about every arm receved lenaldomde wth etherhgh dose or very low dose dexamethasone.OS was sgnfcantly superor the reduced dose dexamethasone group.