{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T15:36:22Z","timestamp":1776699382827,"version":"3.51.2"},"reference-count":31,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH\/NCI Cancer Center Support","award":["P30 CA008748"],"award-info":[{"award-number":["P30 CA008748"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background and Purpose: Adherence to oral anticancer therapy correlates with outcome. Lenalidomide (LEN) is an oral mainstay treatment for multiple myeloma (MM), administered in 21-day\/7-day (on\/off) cycles. Data on LEN adherence is limited. Electronic monitoring (EM) represents the most reliable adherence assessment method. Experimental Approach: We conducted a prospective observational study using electronic medication event monitoring (MEMS\u00ae) in lenalidomide-na\u00efve multiple myeloma patients to quantify adherence during on\/off cycles and identify patterns of non-adherence in real-world practice. On and off cycles were determined semi-automatically. Implementation adherence was calculated as the proportion of prescribed drug taken, during each on cycle and across all on cycles. Daily adherence predictors were analyzed using logistic regression with generalized estimating equations. Key Results: Eighty-five patients were included. Median age was 68 years, 66% received LEN as a second-line treatment, 75% of patients perfectly adhered to the recommended 21\/7-day on\/off cycle. Median implementation adherence was 100%. Only 4% of patients had a proportion of doses taken below 90%. All doses were taken by 51% of patients, while 9% missed \u22654 doses. Among the 13 predictors investigated, only age under 80 and participation in a support group were statistically significant. Conclusions: this novel assessment of LEN adherence in MM patients demonstrated high implementation adherence and cycle duration compliance.<\/jats:p>","DOI":"10.3390\/cancers17213587","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:14:45Z","timestamp":1762506885000},"page":"3587","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["High Implementation Adherence to Lenalidomide in Multiple Myeloma"],"prefix":"10.3390","volume":"17","author":[{"given":"Irina","family":"Amitai","sequence":"first","affiliation":[{"name":"Division of Hematology, Chaim Sheba Medical Center, Ramat-Gan 5262000, Israel"},{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3990-394X","authenticated-orcid":false,"given":"Hila","family":"Magen","sequence":"additional","affiliation":[{"name":"Division of Hematology, Chaim Sheba Medical Center, Ramat-Gan 5262000, Israel"},{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avi","family":"Leader","sequence":"additional","affiliation":[{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva 6356710, Israel"},{"name":"Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1610-3050","authenticated-orcid":false,"given":"Antoine","family":"Pironet","sequence":"additional","affiliation":[{"name":"AARDEX Group, 4432 Ans, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Tousset","sequence":"additional","affiliation":[{"name":"AARDEX Group, 4432 Ans, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alon","family":"Rozental","sequence":"additional","affiliation":[{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva 6356710, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6596-7237","authenticated-orcid":false,"given":"Sabina","family":"De Geest","sequence":"additional","affiliation":[{"name":"Institute of Nursing Science, Department Public Health, University of Basel, 4056 Basel, Switzerland"},{"name":"Academic Centre of Nursing and Midwifery, Department Public Health and Primary Care, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iuliana","family":"Vaxman","sequence":"additional","affiliation":[{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva 6356710, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9973-639X","authenticated-orcid":false,"given":"Pia","family":"Raanani","sequence":"additional","affiliation":[{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva 6356710, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0763-1265","authenticated-orcid":false,"given":"Arnon","family":"Nagler","sequence":"additional","affiliation":[{"name":"Division of Hematology, Chaim Sheba Medical Center, Ramat-Gan 5262000, Israel"},{"name":"The Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5401","DOI":"10.1182\/blood-2008-12-196543","article-title":"Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: The ADAGIO study","volume":"113","author":"Noens","year":"2009","journal-title":"Blood"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2381","DOI":"10.1200\/JCO.2009.26.3087","article-title":"Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib","volume":"28","author":"Marin","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1634\/theoncologist.2015-0405","article-title":"A systematic review of adherence to oral antineoplastic therapies","volume":"21","author":"Greer","year":"2016","journal-title":"Oncologist"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.1200\/JCO.20.03088","article-title":"The randomized AMBORA trial: Impact of pharmacological\/pharmaceutical care on medication safety and patient-reported outcomes during treatment with new oral anticancer agents","volume":"39","author":"Schlichtig","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/0140-6736(90)92095-Y","article-title":"Treatment adherence and risk of death after a myocardial infarction","volume":"336","author":"Horwitz","year":"1990","journal-title":"Lancet"},{"key":"ref_6","first-page":"4043","article-title":"A review of factors influencing non-adherence to oral antineoplastic drugs","volume":"28","author":"Gunn","year":"2020","journal-title":"Support. Care Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/j.1440-172X.2008.01722.x","article-title":"Medication non-adherence\u2014Exploring the conceptual mire","volume":"15","author":"Lehane","year":"2009","journal-title":"Int. J. Nurs. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1111\/j.1365-2125.2012.04167.x","article-title":"A new taxonomy for describing and defining adherence to medications","volume":"73","author":"Vrijens","year":"2012","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1001\/jama.2022.0003","article-title":"Diagnosis and Management of Multiple Myeloma: A Review","volume":"327","author":"Cowan","year":"2022","journal-title":"JAMA"},{"key":"ref_10","unstructured":"Surveillance Research Program, National Cancer Institute (2025, February 10). SEERStat Software*, Version 12, Available online: https:\/\/seer.cancer.gov\/seerstat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1182\/blood.2022017635","article-title":"How I treat multiple myeloma in geriatric patients","volume":"143","author":"Facon","year":"2024","journal-title":"Blood"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1182\/hematology.2021000231","article-title":"Treatment of older adult or frail patients with multiple myeloma","volume":"2021","author":"Grant","year":"2021","journal-title":"Hematology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1056\/NEJMoa2400712","article-title":"Isatuximab, bortezomib, lenalidomide, and dexamethasone for multiple myeloma","volume":"391","author":"Facon","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1038\/s41591-024-03050-2","article-title":"Isatuximab, lenalidomide, dexamethasone and bortezomib in transplant-ineligible multiple myeloma: The randomized phase 3 BENEFIT trial","volume":"30","author":"Leleu","year":"2024","journal-title":"Nat. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1038\/s41591-024-03485-7","article-title":"Daratumumab plus bortezomib, lenalidomide and dexamethasone for transplant-ineligible newly diagnosed multiple myeloma: The CEPHEUS study","volume":"31","author":"Usmani","year":"2025","journal-title":"Nat. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e205","DOI":"10.1016\/S1470-2045(24)00043-3","article-title":"International Myeloma Working Group immunotherapy committee consensus guidelines and recommendations for optimal use of T-cell-engaging bispecific antibodies in multiple myeloma","volume":"25","author":"Usmani","year":"2024","journal-title":"Lancet Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1002\/ajh.26590","article-title":"Multiple myeloma: 2022 update on diagnosis, risk stratification, and management","volume":"97","author":"Rajkumar","year":"2022","journal-title":"Am. J. Hematol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Cransac, A., Aho, S., Chretien, M.L., Giroud, M., Caillot, D., and Boulin, M. (2019). Adherence to immunomodulatory drugs in patients with multiple myeloma. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0214446"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1177\/1078155220980807","article-title":"Adherence to and effectiveness of lenalidomide after 1 year of treatment in a real-world setting","volume":"28","author":"Santoleri","year":"2022","journal-title":"J. Oncol. Pharm. Pract."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.clml.2019.09.618","article-title":"Adherence to lenalidomide in older adults with newly diagnosed multiple myeloma","volume":"20","author":"Mian","year":"2020","journal-title":"Clin. Lymphoma Myeloma Leuk."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1007\/s00277-021-04543-7","article-title":"Oral therapy adherence and satisfaction in patients with multiple myeloma","volume":"100","author":"Solano","year":"2021","journal-title":"Ann. Hematol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.clml.2022.05.003","article-title":"Real-world adherence to and persistence with oral oncolytics in multiple myeloma: A systematic review and meta-analysis","volume":"22","author":"Naser","year":"2022","journal-title":"Clin. Lymphoma Myeloma Leuk."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Schneider, M.P., Achtari Jeanneret, L., Chevaux, B., Backes, C., Wagner, A.D., Bugnon, O., Suter, P.M., Dreher, M., Bourquin, V., and Koch, N. (2018). A novel approach to better characterize medication adherence in oral anticancer treatments. Front. Pharmacol., 9.","DOI":"10.3389\/fphar.2018.01567"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"van Heuckelum, M., van den Ende, C.H.M., Houterman, A.E.J., Heemskerk, C.P.M., van Dulmen, S., and van den Bemt, B.J.F. (2017). The effect of electronic monitoring feedback on medication adherence and clinical outcomes: A systematic review. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0185453"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Bandiera, C., Locatelli, I., Courlet, P., Cardoso, E., Zaman, K., Stravodimou, A., Gotta, V., Csajka, C., Desmeules, J., and Decosterd, L. (2023). Adherence to the CDK 4\/6 inhibitor palbociclib and omission of dose management supported by pharmacometric modelling as part of the OpTAT study. Cancers, 15.","DOI":"10.3390\/cancers15010316"},{"key":"ref_26","unstructured":"AARDEX Group (2020). Using data science to detect key changes in medication intake behaviors. AARDEX White Paper, AARDEX Group."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Hardin, J.W., and Hilbe, J.M. (2002). Generalized Estimating Equations, Chapman and Hall\/CRC.","DOI":"10.1201\/9781420035285"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Altman, D.G. (1990). Practical Statistics for Medical Research, Chapman and Hall\/CRC.","DOI":"10.1201\/9780429258589"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chapman, S.C.E., and Chan, A.H.Y. (2025). Medication nonadherence\u2014Definition, measurement, prevalence, and causes: Reflecting on the past 20 years and looking forwards. Front. Pharmacol., 16.","DOI":"10.3389\/fphar.2025.1465059"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1111\/ajt.15528","article-title":"Improving medication adherence and outcomes in adult kidney transplant patients using a personal systems approach: SystemCHANGE\u2122 results of the MAGIC randomized clinical trial","volume":"20","author":"Russell","year":"2020","journal-title":"Am. J. Transpl."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Neparidze, N., Godara, A., Lin, D., Le, H.H., Fixler, K., Shea, L., Cowan, A., Tsai, L., Chari, A., and Siegel, D.S. (2024). Impact of social needs and identity experiences on the burden of illness in patients with multiple myeloma: A mixed-methods study. Healthcare, 12.","DOI":"10.3390\/healthcare12161660"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/21\/3587\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:26:40Z","timestamp":1762507600000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/21\/3587"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":31,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["cancers17213587"],"URL":"https:\/\/doi.org\/10.3390\/cancers17213587","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,6]]}}}