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 topic on "Prevention and treatment of chemotherapy-induced nausea and vomiting in adults".
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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".
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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 topic on "Thrombotic complications following treatment of multiple myeloma with immunomodulatory drugs (thalidomide, lenalidomide, and pomalidomide)".
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Dose adjustment for baseline liver or renal dysfunction | - Patients with renal 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 topic on "Chemotherapy nephrotoxicity and dose modification in patients with renal insufficiency: Conventional cytotoxic agents".
- Studies have not been conducted in patients with hepatic impairment.
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Monitoring parameters: |
- Assess CBC with differential, electrolytes, renal function, and liver function prior to starting each cycle.
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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.
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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]
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