title: Lenalidomide in multiple myeloma-a practice guideline.
abstract: BACKGROUND
  Promising new drugs such as lenalidomide, an immunomodulatory agent, are available for the treatment of multiple myeloma. We describe the process of creating a provincial guideline for the use of lenalidomide, alone or in combination with other drugs, in relapsed, refractory, or newly diagnosed disease (including smoldering and symptomatic patients, and candidates and non-candidates for transplant) and in maintenance treatment (after transplant or non-transplant therapy); and for strategies to manage lenalidomide-related toxicities.
  
  
  METHODS
  Outcomes of interest included overall survival, event-free survival, progression-free survival, time to progression, time to next treatment, response rate, and incidence of serious toxicity. The medline, embase, and Cochrane Library databases, as well as meeting abstracts and the Web sites of relevant organizations, were systematically searched for relevant literature.
  
  
  RESULTS
  Recommendations were developed using the evidence from published studies and the clinical expertise of the working group and of the Cancer Care Ontario Hematology Disease Site Group.
  
  
  CONCLUSIONS
  Lenalidomide in combination with dexamethasone can be recommended for both previously untreated and treated patients with multiple myeloma. Guidelines for the management of cytopenias, venous thromboembolism, and second primary malignancies are discussed.
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, ON.
authors.forename: C
authors.initials: C
authors.lastname: Chen
authors.forename: F
authors.initials: F
authors.lastname: Baldassarre
authors.forename: S
authors.initials: S
authors.lastname: Kanjeekal
authors.forename: J
authors.initials: J
authors.lastname: Herst
authors.forename: L
authors.initials: L
authors.lastname: Hicks
authors.forename: M
authors.initials: M
authors.lastname: Cheung
keywords: Lenalidomide; imid; multiple myeloma; practice guideline
references.citation: J Clin Oncol. 2007 Dec 1;25(34):5490-505
references.pmid: 17968019
references.citation: J Clin Oncol. 2010 Jan 1;28(1):132-5
references.pmid: 19901114
references.citation: Leukemia. 2009 Nov;23(11):2147-52
references.pmid: 19626046
references.citation: N Engl J Med. 2012 May 10;366(19):1782-91
references.pmid: 22571202
references.citation: Oncologist. 2008 Oct;13(10):1120-7
references.pmid: 18922829
references.citation: Clin Lymphoma Myeloma Leuk. 2011 Feb;11(1):38-43
references.pmid: 21273172
references.citation: Br J Haematol. 2011 Nov;155(3):340-8
references.pmid: 21902684
references.citation: Blood. 2006 Nov 15;108(10):3458-64
references.pmid: 16840727
references.citation: Cancer. 2010 Aug 15;116(16):3807-14
references.pmid: 20564094
references.citation: Blood. 2010 Dec 23;116(26):5838-41
references.pmid: 20876454
references.citation: J Thromb Haemost. 2011 Apr;9(4):653-63
references.pmid: 21255254
references.citation: N Engl J Med. 2012 May 10;366(19):1770-81
references.pmid: 22571201
references.citation: Lancet Oncol. 2010 Jan;11(1):29-37
references.pmid: 19853510
references.citation: J Oncol Pract. 2008 Jan;4(1):48-52
references.pmid: 20859444
references.citation: N Engl J Med. 2012 May 10;366(19):1759-69
references.pmid: 22571200
references.citation: Core Evid. 2010 Jun 15;4:215-45
references.pmid: 20694078
references.citation: Haematologica. 2010 Oct;95(10):1738-44
references.pmid: 20460639
references.citation: N Engl J Med. 2006 May 11;354(19):2079-80
references.pmid: 16687729
references.citation: Blood Cancer J. 2016 Sep 02;6(9):e466
references.pmid: 27588519
references.citation: N Engl J Med. 2007 Nov 22;357(21):2123-32
references.pmid: 18032762
references.citation: Eur J Haematol. 2009 Jun;82(6):426-32
references.pmid: 19302559
references.citation: N Engl J Med. 2007 Nov 22;357(21):2133-42
references.pmid: 18032763
references.citation: Blood. 2008 Dec 1;112(12):4445-51
references.pmid: 18799726
references.citation: Blood. 2012 Jan 26;119(4):933-9; quiz 1093
references.pmid: 21835953
references.citation: J Clin Oncol. 1995 Feb;13(2):502-12
references.pmid: 7844612
references.citation: Blood. 2010 Jul 22;116(3):308-9
references.pmid: 20651078
references.citation: Leukemia. 2011 Oct;25(10):1620-6
references.pmid: 21747400