Abstract
Multiple myeloma is the second most common type of blood cancer and remains incurable despite advances in therapy. Current therapy for multiple myeloma includes a phased-approach, often consisting of initial induction therapy, consolidation and maintenance therapy. With an ever-growing landscape of treatment options, the approach to optimal therapy has become increasingly complex. Specifically, controversy surrounds the optimal use and duration of maintenance therapy. We conducted a comprehensive literature search to analyze the most current literature and to provide recommendations for maintenance therapy in multiple myeloma.
Highlights
Multiple myeloma (MM) is an incurable hematologic malignancy of plasma cells with a median overall survival (OS) of 6.1 years for patients diagnosed since 2006.1 The disease is characterized by periods of active disease requiring systemic therapy followed by periods of relative quiescence dependent on both biology and ongoing treatment
Four randomized controlled trials (RCTs) included the use of autologous stem cell transplant (ASCT), six treatment trials included the use of ASCT and one included the use of allogeneic transplant (Figure 1)
For elderly or transplant ineligible patients with newly diagnosed MM, we evaluated the use of lenalidomide maintenance therapy
Summary
Multiple myeloma (MM) is an incurable hematologic malignancy of plasma cells with a median overall survival (OS) of 6.1 years for patients diagnosed since 2006.1 The disease is characterized by periods of active disease requiring systemic therapy followed by periods of relative quiescence dependent on both biology and ongoing treatment. Interferon therapy was heavily studied and two meta-analysis demonstrated an improvement in OS of 4 and 7 months, respectively.[7,8] there is little data to guide which specific patients may receive benefit from interferon maintenance and toxicity is high with decreased quality of life (QOL),[9] limiting the practical utility of interferon maintenance. The landscape of MM therapy continues to expand further with the approval of generation proteasome inhibitors and immunomodulatory agents as well as the recent approval of new drugs with novel mechanisms of action including monoclonal antibodies and histone deacetylase inhibitors.[15,16,17] With the rapid changes in MM therapy, our goal with this review is to analyze the current literature and provide recommendations for maintenance therapy in MM, primarily with lenalidomide and bortezomib
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