Advances in maintenance strategy in newly diagnosed multiple myeloma patients eligible for autologous transplantation

Expert Rev Hematol. 2020 Dec;13(12):1333-1347. doi: 10.1080/17474086.2020.1839886. Epub 2020 Oct 26.

Abstract

Introduction: Multiple myeloma (MM) lacks curative therapy. Therefore, researchers continue to conduct studies in an effort to improve progression-free survival (PFS) and overall survival (OS). Maintenance therapy (MT) after autologous stem cell transplant (ASCT) was extensively studied in the last decade and now considered a standard approach.

Areas covered: This review evaluated the evidence and updates on various maintenance agents in newly diagnosed multiple myeloma (NDMM) after ASCT. Articles were searched on PubMed and Embase that were published in last 10 years. Both clinical trials and observational studies were evaluated.

Expert opinion: Maintenance strategy after ASCT has consistent PFS benefit but lacks conclusive OS improvement. Lenalidomide is superior to thalidomide given reduced neurotoxicity. OS advantage is controversial for both due to inconsistent evidence. Lenalidomide may confer a PFS advantage even at lower doses due to toxicity with higher doses. Bortezomib-based maintenance has some evidence for OS benefit in high-risk MM (HRMM) and renal dysfunction. Ixazomib has preliminary promising results. Two or three drug combinations for MT are potentially safe and more effective, particularly in HRMM although data on this subject is still evolving. Efficacy of various MT regimens in terms of minimal residual disease status needs to be further investigated.

Keywords: Maintenance therapy; minimal-residual disease; multiple myeloma; overall survival; progression-free survival.

MeSH terms

  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bortezomib / therapeutic use*
  • Clinical Trials as Topic
  • Combined Modality Therapy
  • Dexamethasone / administration & dosage
  • Doxorubicin / administration & dosage
  • Forecasting
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Lenalidomide / therapeutic use*
  • Maintenance Chemotherapy / trends*
  • Multicenter Studies as Topic
  • Multiple Myeloma / drug therapy*
  • Multiple Myeloma / therapy
  • Neoplasm, Residual
  • Nervous System Diseases / chemically induced
  • Progression-Free Survival
  • Proteasome Inhibitors / therapeutic use*
  • Thalidomide / adverse effects
  • Thalidomide / therapeutic use*
  • Transplantation, Autologous
  • Vincristine / administration & dosage

Substances

  • Antineoplastic Agents
  • Proteasome Inhibitors
  • Thalidomide
  • Vincristine
  • Bortezomib
  • Dexamethasone
  • Doxorubicin
  • Lenalidomide

Supplementary concepts

  • VAD I protocol