Consolidation and maintenance regimens in multiple myeloma

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Published: 6 Apr 2013
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Prof Philippe Moreau, Prof Gareth Morgan, Prof Michel Cavo, Prof Antonio Palumbo

Prof Philippe Moreau, Prof Gareth Morgan, Prof Michel Cavo and Prof Antonio Palumbo come together for ecancertv at IMW 2013 to discuss consolidation therapy as being short term and intended to further enhance the frequency and quality of response obtained with the previous treatment phases. In the era of novel agents, consolidation therapy is needed to increase the rate of complete response (CR), even in the transplant setting. Maintenance therapy is a developing concept and is one that is considered to be important in the management of minimal residual disease. A recent meta-analysis of data from the MRC Myeloma IX Study has shown that there was an improvement in progression free survival (PFS) with thalidomide maintenance. The downside to thalidomide therapy was the impaired quality of life associated with this treatment, which resulted in discontinuation at around 7 months in most patients. Lenalidomide is a viable alternative option for maintenance due to the fact that it is an oral drug and is well tolerated. Current dosage regimens in clinical trials in Italy are 3 weeks on and 1 week off, rather than continuous therapy long term. It is well tolerated in the elderly population. It has also been investigated in younger patients following high dose treatment. In these patients it has been associated with benefits in PFS across many patient subgroups. It has also been associated with overall survival (OS). Bortezomib maintenance following autologous stem cell transplant (ASCT) has also been investigated. However, this data was limited in terms of establishing its place as a maintenance option. It has been shown to be beneficial in high risk patients, but more data is needed. In the future it is likely that consolidation and maintenance are likely to be complimentary therapy protocols in the management of multiple myeloma.

This programme has been supported by an unrestricted educational grant from Janssen Pharmaceutica (A Johnson & Johnson Company).