From cell biology to therapy: lenalidomide in untreated multiple myeloma

Multiple myeloma (MM) is a disorder of malignant plasma cells that is characterised by the presence of a monoclonal immunoglobulin in serum and urine. It represents 10% of haematological malignancy and accounts for more than 16 000 deaths every year in Europe.1 Immunomodulatory drugs (IMiDs) are a series of compounds that were developed with use of the first-generation IMiD thalidomide as the leading compound. CC-5013 (lenalidomide, Revlimid®) is derived from the parent compound by the addition of an amino (NH2) group at position 4 of the phtaloyl ring of thalidomide and removal of one of the carbonyl groups.2 It was originally selected for its increased potency as inhibitor of TNF· production and its absence of teratogenicity in preliminary screening.3 Lenalidomide is the leading IMiDs® compound that is being tested, and it has now been approved by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) for use in combination with dexamethasone in patients with MM who have received at least one previous treatment.