For patients with newly diagnosed multiple myeloma (NDMM) receiving dexamethasone induction, dose reductions do not negatively impact survival, according to a study. published online Jan. 2 in blood,

Rahul Banerjee, MD, from the Fred Hutchinson Cancer Center in Seattle, and colleagues conducted a secondary pooled analysis of the SWOG 0777 and SWOG 1211 studies, which examined lenalidomide and dexamethasone alone, with or without bortezomib and with or without elotuzumab for NDMM. In all arms, the planned dexamethasone intensity was 40 to 60 mg weekly. Patients were classified as full-dose dexamethasone throughout induction (FD-DEX) or lowered-dose dexamethasone or discontinuation (LD-DEX), permitted for grade 3+ toxicities per both study protocols.

The LD-DEX group included 373 patients (69%) of the 541 evaluated. The researchers found that progression-free survival (PFS) and overall survival (OS) did not differ between the FD-DEX and LD-DEX groups. In the multivariate models, predictors of PFS and OS were treatment arm, age 70 years or older, and thrombocytopenia.

“Dexamethasone dose reductions <40 to 60 mg per week are quite common even in the setting of clinical trials," the authors write. "These dose reductions do not appear to negatively impact PFS or OS. We encourage future trials to investigate lowered-dose dexamethasone strategies prospectively, either at treatment onset or within a few cycles of treatment initiation."

Several authors disclosed ties to the biopharmaceutical industry.

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