We had an early Christmas with our team's latest work out in @BloodJournal. We investigated the benefit patients derive from Lenalidomide Maintenance in context of tumour genetics. ashpublications.org/blood/article-…
Our aim was to interrogate clinically accessible markers that can support care discussions. The Len Maintenance registration trials included limited genetics. We investigated 556 patients with extended genetics randomized post ASCT to Len Maint or Observation in #MyelomaXI 
Extended genetics included all HRCA del(1p), gain(1q) & t(14;16)/t(14;20) + standard t(4;14) and del(17p), demonstrating the challenge of reporting on individual genetic markers in #myeloma – e.g. >50% of ‘t(4;14) patients’ also carried at least one other HRCA (=double hit).
When taking number of HRCA/hits into account, we found patients with isolated (single hit) del(1p), del(17p) or t(4;14) derived exceptional benefit from Len Maintenance – showing significant PFS and OS improvement over Observation.
Although those with double hit (2+ HRCA) derived PFS benefit with Len Maintenance, median PFS was still <24 month, regardless of the type of HRCAs involved. There is an urgent unmet need for maintaining remissions in these patients – in keeping with excellent MASTER trial results
Depending on the clinical setting, it may be reasonable to take this information into account when discussing Len Maintenance with patients. Some may feel safer on Len Maintenance, others may want to stop – no two patients are the same. But all deserve an informed discussion.
Lenalidomide generics have entered @NHSEngland & other public healthcare systems: drug cost should not dominate the debate anymore; Len should be accessible when & where needed. We should instead focus on patients and their needs, including disease characteristics. #MMsm
We feel our results support wider access for #myeloma patients to extended genetic profiling at diagnosis - results can inform care discussions months or years into the treatment journey and underappreciated in turbulence of a new diagnosis. #MMsm
This has been another fantastic #UKMRA collaboration @NCRI_partners network: 556 patients & their carers, 94 mostly community #NHS hospitals, the fantastic @CTRU_Leeds @kennycairns @profghjackson @_DrCP @HoulstonLab_ICR @JennerMatthew @DrGarethMorgan1 @DrKBoydMyeloma & more
Very grateful to our funders @MyelomaUK @DFNFoundation , infrastructure support by @cancerBRC and⭐️MD(Res) student @drKatPanopoulou @ICR_London
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