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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Chemotherapy regimens for multiple myeloma: Lenalidomide (Revlimid) plus dexamethasone (Rd)[1]

Chemotherapy regimens for multiple myeloma: Lenalidomide (Revlimid) plus dexamethasone (Rd)[1]
Cycle length: 28 days.
Drug Dose and route Administration Given on days
Lenalidomide* 25 mg by mouth Administer with water. Swallow capsule whole; do not break, open, or chew. Take once daily on days 1 through 21
Dexamethasone 40 mg by mouth Take with food (after meals or with food or milk) in the morning. Take once daily on days 1, 8, 15, and 22
Pretreatment considerations:
Emesis risk
  • LOW or VERY LOW.[2]
  • Refer to UpToDate topics on prevention of chemotherapy-induced nausea and vomiting in adults.
Infection prophylaxis
  • Routine primary prophylaxis with G-CSF is not indicated (rate of febrile neutropenia <20%). The use of prophylactic antimicrobials is controversial.
  • Refer to UpToDate topics on treatment of the complications of multiple myeloma and use of granulocyte colony stimulating factors in adult patients with chemotherapy-induced neutropenia and conditions other than acute leukemia, myelodysplastic syndrome, and hematopoietic cell transplantation.
Antithrombotic prophylaxis
  • Routine antithrombotic prophylaxis with aspirin or low-molecular heparin is warranted. The risk of thrombosis in patients with multiple myeloma treated with the Rd regimen is >10%.[1] 
  • Refer to UpToDate topics on thrombotic complications following treatment of multiple myeloma with immunomodulatory drugs (thalidomide, lenalidomide, and pomalidomide).
Dose adjustment for baseline liver or kidney dysfunction
  • Patients with kidney insufficiency experience more neutropenia with the use of lenalidomide.[3] Dose adjustment is recommended for patients with CrCl <60 mL/min.[2] 
  • Refer to UpToDate topics on chemotherapy nephrotoxicity and dose modification in patients with kidney impairment, conventional cytotoxic agents.
  • Studies have not been conducted in patients with hepatic impairment.
Monitoring parameters:
  • Assess CBC with differential, electrolytes, kidney function, and liver function prior to starting each cycle.
Suggested dose modifications for toxicity:
Myelotoxicity
  • If platelets are <30,000/microL or ANC is <1000/microL, hold lenalidomide and follow CBC weekly. Lenalidomide may be resumed at a reduced dose (15 mg daily) once the platelet count rises above 30,000/microL and the ANC is above 1000/microL.[2] If several doses are held, reduce lenalidomide dose to 5 mg less than the previous dose.
Nonhematologic toxicity
  • For grade 3 or 4 nonhematologic toxicity thought to be due to lenalidomide, hold treatment and restart at a reduced dose (5 mg less than previous dose) when toxicity has resolved to grade 2 or less.[2]
This table is provided as an example of how to administer this regimen; there may be other acceptable methods. This regimen must be administered by a clinician trained in the use of chemotherapy, who should use independent medical judgment in the context of individual circumstances to make adjustments, as necessary.

ANC: absolute neutrophil count; CBC: complete blood count; CrCl: creatinine clearance; G-CSF: granulocyte colony-stimulating factors.


* In the United States, the use of lenalidomide is subject to the REVLIMID REMS program (www.REVLIMIDREMS.com) developed in an attempt to minimize the potential for pregnancy and associated birth defects among patients taking this medication.
¶ For frail older adult patients, we decrease the starting doses of lenalidomide (to 15 mg) and dexamethasone (to 20 mg). Following 9 cycles of lenalidomide plus dexamethasone in this population, we discontinue the dexamethasone and continue with lenalidomide maintenance alone.

References:
  1. Rajkumar SV, Jacobus S, Callander NS, et al. Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol 2010; 11:29.
  2. Lenalidomide capsule. United States Prescribing Information. US National Library of Medicine. (Available online at dailymed.nlm.nih.gov, accessed on April 17, 2018).
  3. Niesvizky R, Naib T, Christos PJ, et al. Lenalidomide-induced myelosuppression is associated with renal dysfunction: adverse events evaluation of treatment-naïve patients undergoing front-line lenalidomide and dexamethasone therapy. Br J Haematol 2007; 138:640.
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