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Stem cell transplant in patients with multiple myeloma deepens response in the subset of patients who have not achieved complete response on therapy prior to transplant, Jeffrey A. Zonder, MD, explains. Studies have demonstrated that pretransplant individuals in apparent complete remission, but not minimum residual disease (MRD)–negative, become MRD–negative after transplant, notes Zonder.
Achieving a complete remission is only an intermediate step toward a deeper response, now that MRD testing is available, Sagar Lonial, MD, adds. It is likely that myeloma will recurr if therapy is discontinued after 4 cycles of chemotherapy, even after achieving complete remission, says Lonial.
James R. Berenson, MD, points out that the depth of response is less important in clinics that offer many opportunities for patient treatment. Much of the data that has established the importance of depth of response was evaluated in those parts of the world that offer fewer treatment options, remarks Berenson. In the United States, maintenance therapy can often be given after a complete remission is achieved, resulting in a longer response and preventing recurrence. Berenson’s practice administers bortezomib-based therapy, typically giving bortezomib every other week and maintaining steroids.
For standard-risk patients, Sundar Jagannath, MD, commonly uses lenalidomide maintenance for 2 to 3 years post-transplant and RVD (lenalidomide, bortezomib, and dexamethasone) in high-risk patients. Zonder highlights the importance of selecting regimens that patients can tolerate, as individuals who cannot continue on maintenance therapy will lack sustained benefit.