How Should Maintenance Therapy for Multiple Myeloma Be Prescribed?

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Researchers reviewed current research on maintenance therapy for multiple myeloma and provided recommendations for its application.
Researchers reviewed current research on maintenance therapy for multiple myeloma and provided recommendations for its application.

Multiple myeloma is the second most common type of hematologic cancer, with approximately 30,000 new diagnoses and 12,000 deaths projected for 2016.1 Despite advances in treatment, including the development of novel drugs and autologous stem cell transplant (ASCT), the disease remains incurable, with a median overall survival (OS) of 6.1 years.2

Current therapy for multiple myeloma involves a phased approach, which includes initial induction therapy, consolidation therapy, and maintenance therapy. Maintenance therapy is used primarily to prevent relapse and increase progression-free survival (PFS), though its effectiveness in treating multiple myeloma is controversial.

In a recent review of literature in Blood Cancer Journal, Brea Lipe, MD, of the University of Rochester in New York, and colleagues examined current research on maintenance therapy for multiple myeloma and provided recommendations for its application. They reviewed 26 studies that discussed the use of lenalidomide or bortezomib for maintenance therapy, and included studies of both transplant eligible and transplant ineligible patients.

Dr Lipe's team evaluated the use of lenalidomide maintenance therapy for transplant ineligible patients in 4 trials, and found that it consistently improved PFS, and in some cases, OS, and had higher tolerability compared to thalidomide. In 3 trials involving bortezomib, only a “minimal” increase in toxicity during maintenance therapy was found.

RELATED: Institutional Care Volume May Affect Clinical Outcomes in Multiple Myeloma

For transplant eligible patients, the authors reviewed 3 trials of patients who received lenalidomide maintenance therapy following ASCT and observed an improved OS. For the same population, 2 trials involved bortezomib: 1 demonstrated improved depth of response, and 1 showed improved PFS and OS for the maintenance arm.

One study examined patients with high-risk multiple myeloma who, following ASCT, received combined lenalidomide, bortezomib, and dexamethasone maintenance therapy followed by indefinite lenalidomide maintenance. This regimen showed a median PFS of 32 months and 3-year OS of 93%.

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