June 7, 2019, by NCI StaffThe drug lenalidomide (Revlimid) may delay the development of multiple myeloma in individuals with smoldering myeloma that is at high risk of progressing to cancer, according to preliminary results from a clinical trial. Smoldering myeloma is a precancerous condition that alters certain proteins in blood and/or increases plasma cells in bone marrow, but it does not cause symptoms of disease. About half of those diagnosed with the condition, however, will develop multiple myeloma within 5 years. Because there are no approved treatments for smoldering myeloma, doctors have long adopted a “watch and wait” approach, closely monitoring individuals for evidence of progression to active (symptomatic) multiple myeloma, such as damage to certain organs. But by the time symptoms of multiple myeloma appear, the disease may have caused painful and debilitating health problems, including bone fractures and kidney failure. In the NCI-supported clinical trial, researchers found that lenalidomide—which is already used to treat multiple myeloma—may delay or slow the progression of smoldering myeloma. Individuals who received the drug had a reduced risk of developing multiple myeloma within 3 years, compared with individuals who were observed for symptoms of cancer during the same period, according to Sagar Lonial, M.D., chief medical officer at Winship Cancer Institute of Emory University, who led the trial. More than half of the participants in the trial who were receiving the drug stopped taking it because of side effects, such as fatigue. In most of these patients, the side effects were treatable, noted Dr. Lonial. He discussed the findings May 15 during a press briefing that featured studies to be presented at the upcoming annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago. The new results, together with findings from previous studies, point to the potential for using therapies like lenalidomide in individuals with smoldering myeloma who are at high risk of progressing to cancer, Dr. Lonial said.