Maintenance in myeloma – pro
The role of maintenance therapy in multiple myeloma is controversial. A number of different maintenance strategies have been evaluated without clear benefit for one therapy versus another or, a clear benefit of any specific therapy in terms of prolonging remission or overall survival.
Recently, a study by the Southwest Oncology Group (SWOG) noted that patients receiving prednisone at a starting dose of 50 mg three times a week had excellent remission duration and survival, indicating that this could be a good maintenance strategy. In the 1980s, Franco Mandelli published results suggesting that using interferon could prolong the disease-free interval for patients with multiple myeloma. Subsequent studies have failed to confirm this effect, although not all the studies have been negative.Aredia is another agent that is being studied. There are three studies with thalidomide that suggest benefit and maintenance with Revlimid and/or Velcade is in clinical trials.
Total 3 regimens include a multidrug regimen maintenance phase with Revlimid and Velcade. This continues to be investigated.
The role of maintenance therapy in multiple myeloma is controversial. A number of different maintenance strategies have been evaluated without clear benefit for one therapy versus another or, a clear benefit of any specific therapy in terms of prolonging remission or overall survival.
Recently, a study by the Southwest Oncology Group (SWOG) noted that patients receiving prednisone at a starting dose of 50 mg three times a week had excellent remission duration and survival, indicating that this could be a good maintenance strategy. In the 1980s, Franco Mandelli published results suggesting that using interferon could prolong the disease-free interval for patients with multiple myeloma. Subsequent studies have failed to confirm this effect, although not all the studies have been negative.Aredia is another agent that is being studied. There are three studies with thalidomide that suggest benefit and maintenance with Revlimid and/or Velcade is in clinical trials.
Total 3 regimens include a multidrug regimen maintenance phase with Revlimid and Velcade. This continues to be investigated. NCCN recommends interferon, Revlimid, thalidomide with or withotu steroids, and steroids as level 2B evidence.
The Myeloma Trialists’ Collaborative Group. Interferon as therapy for multiple myeloma: an individual patient data overview of 24 randomized trials and 4012 patients. Br J Haematol. 2001;113:1020-1034.
NCCN.org, myeloma 2011
Ashraf Z. Badros, MD The Role of Maintenance Therapy in the Treatment of Multiple Myeloma J Natl Compr Canc Netw 2010;8:S-21-S-27
For the post-transplantation maintenance see here