The definition of maintenance therapy for myeloma is extended drug therapy, administered after achieving a remission or a plateau phase, or in this case when disease is at its minimum. Defining the dose, schedule, and the clinical scenario for maintenance therapy is an important starting point. The ideal maintenance therapy is easily delivered (oral) and, if given intravenously, has a schedule that is convenient for patients. The toxicity from the maintenance agent should be modest and its use should improve progression-free survival (PFS). Ideally, the use of the maintenance treatment should not only improve PFS but also improve OS compared with re-treatment at the time of relapse. Such goals for maintenance therapy allow clinicians to target populations, agents, and schedules that are patient friendly and demonstrate efficacy.
Current evidence does not support the use of IFN as maintenance therapy owing to its lack of improvement in OS and unacceptable toxicity. The scant data that are available do not justify the recommendation of corticosteroids as maintenance therapy for all patients. Conflicting evidence exists for the use of thalidomide as maintenance treatment. Current data are promising, but further randomized trials are needed to verify its effectiveness and those who will most likely benefit from maintenance thalidomide. More randomized trials are needed in order to make clear recommendations to patients regarding maintenance therapy. The most recent trial was of lenalidomide with positive results( McCarthy et al). In addition to PFS, OS and quality of life measures are needed. VDT-PACE,as a part of the Total Therapy III approach is a novel maintenance starategy which is investigational as well at this time
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Philip L. McCarthy, Kouros Owzar, Craig C. Hofmeister, David D. Hurd, Hani Hassoun, Paul G. Richardson, Sergio Giralt, Edward A. Stadtmauer, Daniel J. Weisdorf, Ravi Vij, Jan S. Moreb, Natalie Scott Callander, Koen Van Besien, Teresa Gentile, Luis Isola, Richard T. Maziarz, Don A. Gabriel, Asad Bashey, Heather Landau, Thomas Martin, Muzaffar H. Qazilbash, Denise Levitan, Brian McClune, Robert Schlossman, Vera Hars, John Postiglione, Chen Jiang, Elizabeth Bennett, Susan Barry, Linda Bressler, Michael Kelly, Michele Seiler, Cara Rosenbaum, Parameswaran Hari, Marcelo C. Pasquini, Mary M. Horowitz, Thomas C. Shea, Steven M. Devine, Kenneth C. Anderson, Charles Linker. Lenalidomide after Stem-Cell Transplantation for Multiple Myeloma. New England Journal of Medicine, 2012; 366 (19):
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