International Journal of Clinical Pharmacy

, Volume 39, Issue 4, pp 836–843 | Cite as

Using pharmacy management systems for research: survival outcomes for lenalidomide in multiple myeloma in the clinical setting

  • Megan M. Sharkey
  • Daniel McKavanagh
  • Euan Walpole
  • Peter Mollee
  • Samantha A. HollingworthEmail author
Research Article


Background Health records can be used to measure medicine use and health outcomes. The public subsidy of lenalidomide in Australia was based on two phase III trials showing improved survival. Objective To use hospital pharmacy information management systems to determine survival outcomes for lenalidomide as a second line treatment in relapsed or refractory multiple myeloma (RRMM) patients. Setting Five public hospitals in Queensland, Australia. Method We extracted data on medicine use and survival for RRMM patients planned to start lenalidomide from pharmacy management and pathology databases. Descriptive statistical analyses (Kaplan–Meier curves) were used to calculate overall survival. Main outcome measure Overall survival. Results There were 136 patients who received at least one lenalidomide dose and 2234 cycles were ordered. The median age was 69 years and 54% were male. Two lenalidomide containing protocols were considered: 90% of patients had lenalidomide plus dexamethasone; 18% had lenalidomide plus dexamethasone with cyclophosphamide. The median starting lenalidomide dose was 20 mg (range 4.3–25 mg) on days 1–21 of a 28-day cycle. Median time on treatment 9.4 months (range 0.5–71.7 months). Median overall survival was 45.4 months (range 12.0–70.5 months). Conclusion The median survival in our study compared favourably to clinical trials. Patients and clinicians can be reassured that outcomes in this clinical setting are as good as those observed in trials.


Australia Lenalidomide Multiple myeloma Pharmacy information system Refractory Relapsed Survival 



The authors wish to thank Dr Joshua Richmond (Toowoomba Health Service), Dr Jeremy Wellwood (Gold Coast University Hospital), and Dr Kathryn Jackson (Nambour General Hospital) for their collaboration. We wish to thank the five Queensland public hospitals sites that provided data (Princess Alexandra Hospital, Toowoomba Health Service, Gold Coast University Hospital, Nambour General Hospital and Gympie Health Service); as well as the staff who entered the information into the databases at the Queensland Health sites. We thank the patients whose medical information were made available for this study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. It was funded from existing salaries.



Conflicts of interest

PM is a member of the Myeloma Advisory Board of Celgene Australia. All other authors declare that the research was conducted in the absence of any commercial or financial interests.


  1. 1.
    Ludwig HH. International Myeloma working group recommendations for global myeloma care. Leukemia. 2014;28(5):981–92.CrossRefPubMedGoogle Scholar
  2. 2.
    Australian Institute of Health and Welfare & Australasian Association of Cancer Registries. Cancer in Australia: an overview, vol. 74., Cancer seriesCanberra: Australian Institute of Health and Welfare; 2012.Google Scholar
  3. 3.
    Smith D, Yong K. Multiple myeloma. BMJ. 2013;346:f3863.CrossRefPubMedGoogle Scholar
  4. 4.
    Fink EC, Ebert BL. The novel mechanism of lenalidomide activity. Blood. 2015;126(21):2366–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Dimopoulos MA, Terpos E, Niesvizky R. How lenalidomide is changing the treatment of patients with multiple myeloma. Crit Rev Oncol Hematol. 2013;88(Suppl 1):S23–35.CrossRefPubMedGoogle Scholar
  6. 6.
    Zelis NN. Treatment with lenalidomide (Revlimid®), cyclophosphamide (Endoxan®) and prednisone (REP) in relapsed/refractory multiple myeloma patients: results of a single centre retrospective study. Acta Clin Belg. 2014;69(2):98–103.CrossRefPubMedGoogle Scholar
  7. 7.
    Australian Government Department of Health—Pharmaceutical Benefits Advisory Committee. Public summary document: lenalidomide (November 2008). Accessed 3 Feb 2017.
  8. 8.
    Dimopoulos MMD, Spencer AMD, Attal MMD, Prince HMMD, Harousseau J-LMD, Dmoszynska AMD, et al. Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N Engl J Med. 2007;357(21):2123–32.CrossRefPubMedGoogle Scholar
  9. 9.
    Weber DM, Chen C, Niesvizky R, Wang M, Belch A, Stadtmauer EA, et al. Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. N Engl J Med. 2007;357(21):2133–42.CrossRefPubMedGoogle Scholar
  10. 10.
    Wang M, Dimopoulos MA, Chen C, Cibeira MT, Attal M, Spencer A, et al. Lenalidomide plus dexamethasone is more effective than dexamethasone alone in patients with relapsed or refractory multiple myeloma regardless of prior thalidomide exposure. Blood. 2008;112(12):4445–51.CrossRefPubMedGoogle Scholar
  11. 11.
    Australian Institute of Health and Welfare. What is chronic kidney disease?. Canberra: Australian Institute of Health and Welfare; 2015.Google Scholar
  12. 12.
    Therapeutic Guidelines Limited. Antibiotic eTG: renal impairment and antimicrobial dosing (Appendix 2.6). 2016 Accessed 03 Feb 2017.
  13. 13.
    Palumbo A, Rajkumar SV, San Miguel JF, Larocca A, Niesvizky R, Morgan G, et al. International myeloma working group consensus statement for the management, treatment, and supportive care of patients with myeloma not eligible for standard autologous stem-cell transplantation. J Clin Oncol. 2014;32(6):587–600.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2017.
  15. 15.
    Abd ElHafeez S, Torino C, D’Arrigo G, Bolignano D, Provenzano F, Mattace-Raso F, et al. An overview on standard statistical methods for assessing exposure-outcome link in survival analysis (Part II): the Kaplan–Meier analysis and the Cox regression method. Aging Clin Exp Res. 2012;24(3):203–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Australian Government Department of Health. Pharmaceutical benefits scheme (PBS). 2016 Accessed 3 Feb 2017.
  17. 17.
    Stadtmauer EA, Weber DM, Niesvizky R, Belch A, Prince MH, San Miguel JF, et al. Lenalidomide in combination with dexamethasone at first relapse in comparison with its use as later salvage therapy in relapsed or refractory multiple myeloma. Eur J Haematol. 2009;82(6):426–32.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Cancer Institute New South Wales. Multiple myeloma: chemotherapy protocols. 2015 Accessed 3 Feb 2017.
  19. 19.
    Boyd KD, Ross FM, Chiecchio L, Dagrada G, Konn ZJ, Tapper WJ, et al. Gender disparities in the tumor genetics and clinical outcome of multiple myeloma. Cancer Epidemiol Biomark Prev. 2011;20(8):1703–7.CrossRefGoogle Scholar
  20. 20.
    Pulte D, Redaniel MT, Brenner H, Jansen L, Jeffreys M. Recent improvement in survival of patients with multiple myeloma: variation by ethnicity. Leuk Lymphoma. 2014;55(5):1083–9.CrossRefPubMedGoogle Scholar
  21. 21.
    O’Brien ME, Borthwick A, Rigg A, Leary A, Assersohn L, Last K, et al. Mortality within 30 days of chemotherapy: a clinical governance benchmarking issue for oncology patients. Br J Cancer. 2006;95(12):1632–6.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Brown RE, Stern S, Dhanasiri S, Schey S. Lenalidomide for multiple myeloma: cost-effectiveness in patients with one prior therapy in England and Wales. Eur J Health Econ. 2013;14(3):507–14.CrossRefPubMedGoogle Scholar
  23. 23.
    Möller JJ. Cost-effectiveness of novel relapsed-refractory multiple myeloma therapies in Norway: lenalidomide plus dexamethasone vs bortezomib. J Med Econ. 2011;14(6):690.CrossRefPubMedGoogle Scholar
  24. 24.
    Alegre AA. Lenalidomide is effective as salvage therapy in refractory or relapsed multiple myeloma: analysis of the Spanish compassionate use registry in advanced patients. Int J Hematol. 2011;93(3):351–60.CrossRefPubMedGoogle Scholar
  25. 25.
    Kim K, Kim SJ, Voelter V, Suh C, Yoon SS, Lee JJ, et al. Lenalidomide with dexamethasone treatment for relapsed/refractory myeloma patients in Korea-experience from 110 patients. Ann Hematol. 2014;93(1):113–21.CrossRefPubMedGoogle Scholar
  26. 26.
    Kneppers EE. Analysis of efficacy and prognostic factors of lenalidomide treatment as part of a Dutch compassionate use program. Clin Lymphoma Myeloma Leuk. 2010;10(2):138–43.CrossRefPubMedGoogle Scholar
  27. 27.
    Kobayashi T, Kuroda J, Fuchida S, Kaneko H, Yagi H, Shibayama H, et al. Impact of early use of lenalidomide and low-dose dexamethasone on clinical outcomes in patients with relapsed/refractory multiple myeloma. Int J Hematol. 2015;101(1):37–45.CrossRefPubMedGoogle Scholar
  28. 28.
    Zago M, Oehrlein K, Rendl C, Hahn-Ast C, Kanz L, Weisel K. Lenalidomide in relapsed and refractory multiple myeloma disease: feasibility and benefits of long-term treatment. Ann Hematol. 2014;93(12):1993–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Zambello R, Bonaldi L, Berno T, Martines A, Sechettin E, De March E, et al. Cytogenetic impact on lenalidomide treatment in relapsed/refractory multiple myeloma: a real-life evaluation. Clin Lymphoma Myeloma Leuk. 2015;15(10):592–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Han JM, Ah YM, Suh SY, Jung SH, Hahn HJ, Im SA, et al. Clinical and economic impact of pharmacists’ intervention in a large volume chemotherapy preparation unit. Int J Clin Pharm. 2016;38:1124–32.CrossRefPubMedGoogle Scholar
  31. 31.
    Ribed A, Romero-Jimenez RM, Escudero-Vilaplana V, Iglesias-Peinado I, Herranz-Alonso A, Codina C, et al. Pharmaceutical care program for onco-hematologic outpatients: safety, efficiency and patient satisfaction. Int J Clin Pharm. 2016;38(2):280–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  • Megan M. Sharkey
    • 1
    • 2
  • Daniel McKavanagh
    • 3
  • Euan Walpole
    • 4
  • Peter Mollee
    • 5
    • 6
  • Samantha A. Hollingworth
    • 1
    Email author
  1. 1.School of PharmacyUniversity of QueenslandWoolloongabbaAustralia
  2. 2.Gold Coast University HospitalSouthportAustralia
  3. 3.Charm Implementation Manager, Icon Cancer Care Head OfficeSouth BrisbaneAustralia
  4. 4.Princess Alexandra Hospital Cancer ServicesWoolloongabbaAustralia
  5. 5.Department of HaematologyPrincess Alexandra HospitalWoolloongabbaAustralia
  6. 6.School of MedicineThe University of QueenslandWoolloongabbaAustralia

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