Should I do the Iberdomide trial or the standard treatment?

Hi  Paul,    Vespa  here  AKA  Kevin       i had SCT  about  18 months ago,  and  was on Lenolidamide,         first reduced dose then 100%  off it,  due to    severe skin reaction,   but aware this is,   the go to  drug for  1st line   MM  with post SCT,    i had heard of Iberdomide in trials,  in conjunction  with Dexamethosone,         i under stand it is still under trial,  but results are very good.   i can  not advise what you should do,   and if your Haemotologist  are   guding you that way,   if it was me  i would take it    probably due to   hindsight of my reaction,   it has not been offered to me, and i will still be   blood test monitored,       i hope you fell  OK post stem cell,  it is still early days,  and we all know  what it can take out of you !      do you still have the  2 cycles of DVTD?       I hope others can offer some real time   knowledge about this,   just to wish you a good and speedy recovery and keep safe from infections     Kevin

Hi Paul.

This is a difficult medical decision. For the record, I have MM but I am not a doctor.

Lenalidomide is the current standard immunomodulatory (IMID) drug given in maintenance. Iberdomide is a leading edge CELMoD treatment, and is in clinical trials. Both of them target cereblon.

There has been some initial research comparing the two, in  a trial called EMN26. 

Lenalidomide vs Iberdomide as maintenance post-ASCT Preliminary results:

https://ashpublications.org/blood/article/142/Supplement%201/208/502084/Iberdomide-Maintenance-after-Autologous-Stem-Cell

Summary of EMN26: Lenalidomide vs Iberdomide as maintenance post-ASCT

Iberdomide led to greater deepening of response (more patients improved from partial to very good partial or complete response).

Fewer patients stopped iberdomide due to side effects

Trial ongoing, not yet practice-changing

In short, in your shoes I would go for Iberdomide. It is, of course, your decision.

Hi Kevin. Thanks so much for your reply and for your kind words. I've finished the DVTD and will begin maintenance when I've decided which rug to go with (standard or trial). What has your oncologist advised as the next step for you? Best wishes in a speedy recovery. Paul

Hi Chicken. Thanks very much for your reply. Much appreciated. How is your treatment going? Wishing you all the best. Paul

Hi Paul.

Thanks for asking: I was carefully not mentioning my own situation as I didn't want that to influence you! However, as you asked...

I have been in remission since 2023. I have been on lenalidomide and daratumumab since then.

At the end of 2024, the lenalidomide dose was reduced from 10mg to 5mg due to diarrhoea and increased fatigue. Sometimes lenalidomide side effects start or get worse years after starting to take it.

A few months ago, my platelet levels went below the 50 minimum allowed for continuing the lenalidomide. The lenalidomide might have caused the low platelets but as of last week my platelets were still only 35. I have had a bone biopsy to help my consultant figure out what is going on, as he is mystified. Awaiting results.

In short, like Vespa, lenalidomide has messed me up! As I said, not trying to influence you, though.

Hi. Again.   I am doing good and I take things in my stride   Try not to worry about things and live for now !     We did discuss the new approved second line treatment of Blenrep.  But only when ( and if).  I relapse.      Kevin 

Hey Kevin. I totally agree about recognising and enjoying the good moments and riding the bad as best you can. I don't worry about things in general. You can't control everything and I think it's better to occupy your mind with positive thoughts than speculation of what can happen to you. Do what you can while you can. And that concludes my string of cliches! Best of luck with the Blentrep treatment Kevin. Paul