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Triplet Regimens, Maintenance Therapy New Standards for Multiple Myeloma

Danielle Bucco
Published: Friday, Nov 03, 2017

Alfred L. Garfall, MD
Alfred L. Garfall, MD
The multiple myeloma paradigm continues to expand and evolve as long-term results become available, with constantly changing roles for stem cell transplant, immunomodulatory agents, and maintenance therapy and the imminent introduction of chimeric antigen receptor (CAR)-modified T-cell therapies, explained Alfred L. Garfall, MD, MS.

, Garfall, discussed the treatment and management of patients with multiple myeloma, with a focus on maintenance therapy, CAR T-cell therapy, and the role of transplant. He also highlighted the importance of aggressive therapy for patients with renal insufficiency.

OncLive®: Can you please provide an overview of your presentation?

Garfall: I focused on data that have come out over the last few years for managing first-line therapy for multiple myeloma that we believe is best. The first systemic therapy that patients receive are consolidation strategies, stem cell transplants, and maintenance therapies to attempt to maintain a response.

In the last year, the meta-analyses of long-term follow-up within 3 large clinical trials compared maintenance therapy with placebo or no maintenance therapy showing that there is an OS benefit to maintenance lenalidomide.

With these novel options, what role will transplant have in the future of this landscape?

There will still be a role for transplant. If transplant was 1 out of 100 therapies that we have for this disease, it would be easy to set it aside. However, as it is only 1 of 12 or so therapies, it will continue to play a role despite the inconvenience and adverse events. For the short-term, most patients do get through it with proper supportive care and recovery.

Until we discover a similar R-CHOP therapy for myeloma, where we find just the right combination of novel medications that can potentially cure some patients, there will be a role for transplant because it is an active therapy. As long as patients are still relapsing, we should be trying to give them every active therapy, in some form, over the course of their disease until that supply of new therapies becomes so plentiful that transplant is just one of many alternatives.


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