Lenalidomide Maintenance in multiple myeloma: NICE Guidance

Dear Clinicians, MDT leads and Pharmacists,

In January 2021 NICE approved Lenalidomide maintenance for use in patients with multiple myeloma who have undergone stem cell transplantation as part of first line treatment.

This is a huge leap forward for care of myeloma patients in the UK. The specific recommendations are outlined in the Blueteq here. Contrary to previous STA’s on multiple myeloma, the start timing of this intervention is flexible and are left entirely to the clinician’s discretion depending on the individual patient situation:

Point 6 in the Blueteq form. The prescribing clinician understands that maintenance Lenalidomide is recommended to start at about day 100 after stem cell transplantation.

The protocol in the MRC MMXI trial on which this guidance is primarily based is worded in a very similar way and permitted flexibility of up to 9 months post transplantation before maintenance treatment was commenced.

We recommend that local MDTs adopt a flexible approach and make an individualised clinical decision with respect to the timing of commencing Lenalidomide maintenance treatment for this patient group. This will give the maximum number of patients the greatest possible benefit from this intervention.

Kind regards

Dr John Ashcroft
UKMF Chair