Annamaria Brioli1,2, Kirsi Manz3, Markus Pfirrmann3, Mathias Hänel4, Andreas Christoph Schwarzer5, Gabriele Prange-Krex6, Christian Fabisch7, Stefan Knop8, Thomas Illmer9, Beate Krammer-Steiner10, Andreas Hochhaus7, Marie von Lilienfeld-Toal7, Lars-Olof Mügge7,11. 1. Universitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Hämatologie und Internistische Onkologie, Am Klinikum 1, 07747, Jena, Germany. annamaria.brioli@med.uni-jena.de. 2. Research Programm "Else Kröner-Forschungskolleg AntiAge", Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany. annamaria.brioli@med.uni-jena.de. 3. Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Munich, Germany. 4. Klinik für Innere Medizin III, Klinikum Chemnitz, Chemnitz, Germany. 5. OnkoFor Leipzig GmbH, Leipzig, Germany. 6. Gemeinschaftspraxis Mohm/Prange-Krex, Dresden, Germany. 7. Universitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Hämatologie und Internistische Onkologie, Am Klinikum 1, 07747, Jena, Germany. 8. Medizinische Klinik II, Universitätsklinikum Würzburg, Würzburg, Germany. 9. BAG/Onkologische Schwerpunktpraxis, Dresden, Germany. 10. Klinikum Südstadt Rostock, Rostock, Germany. 11. Heinrich-Braun-Klinikum, Klinik für Innere Medizin III (Hämatologie, Onkologie und Palliativmedizin), Zwickau, Germany.
Abstract
PURPOSE: The German Maintenance Study (GERMAIN) was designed to evaluate the impact of lenalidomide maintenance after induction therapy with bortezomib, melphalan and prednisolone (VMP) in transplant-ineligible newly diagnosed multiple myeloma (MM) patients. METHODS: Due to poor accrual and high dropout rate, only 85 patients (planned 286) entered the trial and 40 (planned 200) were randomized to lenalidomide maintenance (n = 19) vs. observation (n = 21). RESULTS: The primary endpoint, improved progression-free survival, was not met (p = 0.3572). After a median follow-up of 12.9 months, median progression-free survival in the lenalidomide arm was 14.4 months and 11.4 months with placebo. The hazard ratio 0.621 (95% confidence interval: [0.224, 1.725]) was about the same as expected (0.625). However, with only 40 patients randomized, the actual power to detect a difference was 11%. Of patients receiving at least one dose of induction, 54% were frail according to a modified International Myeloma Working Group frailty score. Discontinuations were high during induction (47%), and affected mainly frail patients (54%). Despite a higher rate of adverse events in the lenalidomide arm (p = 0.0061), only 2 patients discontinued lenalidomide due to toxicity. CONCLUSION: A frailty assessment with appropriate dose modification for induction therapy should be mandatory for all elderly non-transplant-eligible myeloma patients.
RCT Entities:
PURPOSE: The German Maintenance Study (GERMAIN) was designed to evaluate the impact of lenalidomide maintenance after induction therapy with bortezomib, melphalan and prednisolone (VMP) in transplant-ineligible newly diagnosed multiple myeloma (MM) patients. METHODS: Due to poor accrual and high dropout rate, only 85 patients (planned 286) entered the trial and 40 (planned 200) were randomized to lenalidomide maintenance (n = 19) vs. observation (n = 21). RESULTS: The primary endpoint, improved progression-free survival, was not met (p = 0.3572). After a median follow-up of 12.9 months, median progression-free survival in the lenalidomide arm was 14.4 months and 11.4 months with placebo. The hazard ratio 0.621 (95% confidence interval: [0.224, 1.725]) was about the same as expected (0.625). However, with only 40 patients randomized, the actual power to detect a difference was 11%. Of patients receiving at least one dose of induction, 54% were frail according to a modified International Myeloma Working Group frailty score. Discontinuations were high during induction (47%), and affected mainly frail patients (54%). Despite a higher rate of adverse events in the lenalidomide arm (p = 0.0061), only 2 patients discontinued lenalidomide due to toxicity. CONCLUSION: A frailty assessment with appropriate dose modification for induction therapy should be mandatory for all elderly non-transplant-eligible myelomapatients.
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