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Maintenance Therapy in Multiple Myeloma

Panelists:
Published: Monday, Aug 24, 2015

 
Maintenance therapy in multiple myeloma can be administered short-term, continuously, or for a duration determined by clinical endpoints and risk. However, it is unclear which patients will benefit the most from each of these strategies. For continuous maintenance therapy, Noopur Suresh Raje, MD, recommends utilizing lenalidomide, based on CALGB 100104 data. In this study, maintenance treatment was continued until disease progression or toxicity, says Raje.

At a 65 month follow-up of the CALGB study, lenalidomide maintenance resulted a time to progressive disease of 53 months versus 27 months with placebo in patients with multiple myeloma (HR, 0.54; P <.001). At the time of the analysis, median overall survival (OS) had not been reached for the lenalidomide arm and was 76 months for placebo (HR, 0.60; P = .001). At this time, this is study provides the only data available on OS for maintenance lenalidomide, notes Heather J. Landau, MD.

In patients with high-risk multiple myeloma, proteasome inhibitors can be utilized as maintenance therapy, says Rafael Fonseca, MD. However, the benefits of these therapies are unclear for patients with low-risk disease. Additionally, some patients do well without maintenance therapy, says Fonseca, and other patients have a long period of disease control with continuous administration of lenalidomide. Rather than immediately initiating maintenance therapy, there should also be a conversation about stem cell transplant.

Even with the advances being made with novel therapies, stem cell transplant still maintains a vital role in the treatment of patients with multiple myeloma, states Jatin J. Shah, MD. Twenty years of experience in multiple randomized trials has shown that transplant improves OS. Clinicians cannot assume that novel agents will replace the need for transplants, states Shah, unless there are data supporting that transplant is no longer necessary. As research evolves, characteristics for selecting which patients should receive transplant should be developed, comments Raje, to avoid the toxicities associated with these procedures.
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Maintenance therapy in multiple myeloma can be administered short-term, continuously, or for a duration determined by clinical endpoints and risk. However, it is unclear which patients will benefit the most from each of these strategies. For continuous maintenance therapy, Noopur Suresh Raje, MD, recommends utilizing lenalidomide, based on CALGB 100104 data. In this study, maintenance treatment was continued until disease progression or toxicity, says Raje.

At a 65 month follow-up of the CALGB study, lenalidomide maintenance resulted a time to progressive disease of 53 months versus 27 months with placebo in patients with multiple myeloma (HR, 0.54; P <.001). At the time of the analysis, median overall survival (OS) had not been reached for the lenalidomide arm and was 76 months for placebo (HR, 0.60; P = .001). At this time, this is study provides the only data available on OS for maintenance lenalidomide, notes Heather J. Landau, MD.

In patients with high-risk multiple myeloma, proteasome inhibitors can be utilized as maintenance therapy, says Rafael Fonseca, MD. However, the benefits of these therapies are unclear for patients with low-risk disease. Additionally, some patients do well without maintenance therapy, says Fonseca, and other patients have a long period of disease control with continuous administration of lenalidomide. Rather than immediately initiating maintenance therapy, there should also be a conversation about stem cell transplant.

Even with the advances being made with novel therapies, stem cell transplant still maintains a vital role in the treatment of patients with multiple myeloma, states Jatin J. Shah, MD. Twenty years of experience in multiple randomized trials has shown that transplant improves OS. Clinicians cannot assume that novel agents will replace the need for transplants, states Shah, unless there are data supporting that transplant is no longer necessary. As research evolves, characteristics for selecting which patients should receive transplant should be developed, comments Raje, to avoid the toxicities associated with these procedures.
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