Maintenance treatment of multiple myeloma: evidence from recent clinical trials

Author(s): Donna E Reece

Maintenance therapy with novel agents has recently been investigated in both transplant-eligible and -ineligible myeloma patients. In Phase III trials, thalidomide, lenalidomide and bortezomib have consistently improved progression-free survival after autologous stem cell transplantation, with variable effects on overall survival. In elderly patients, induction regimens combining melphalan and prednisone with novel agents, followed by maintenance with thalidomide, combinations of bortezomib with thalidomide or prednisone, and lenalidomide have also extended progression-free survival. However, to date, no survival advantage has emerged. Longer follow-up is awaited to assess the long-term consequences of maintenance therapy as well as to identify subgroups of patients in whom maintenance might be most appropriate.