Consolidation and maintenance therapy for multiple myeloma after autologous transplantation: where do we stand?

Abstract

Novel agents including proteasome inhibitors and immunomodulatory drugs are now routinely utilized as part of the induction regimen before transplantation and this has resulted in substantial improvements in the depth of response achieved before transplant. Given that depth of response is prognostic for overall outcome, a number of studies have been conducted or are ongoing to investigate the use of novel agents as consolidation and maintenance therapy after transplant. Most clinical trials have reported after consolidation and maintenance therapy an increased PFS and even overall survival in some of them. The use of postautologous stem cell transplant consolidation and maintenance is an increasingly attractive concept. However, some side effects could be observed with such long-term therapy and many open questions are still under debate. The decision to administer consolidation and/or maintenance therapy will likely need to be guided by the individual patient situation. This review aims to analyze the currently available research evidence in this field.

Recovery of polyclonal immunoglobulins one year after autologous stem cell transplantation as a long-term predictor marker of progression and survival in multiple myeloma

“…Despite there being no definitive recommendations regarding consolidation and maintenance treatment for MM patients after ASCT, 26 strategies that enhance the immune reconstitution might be beneficial. In fact, interferon maintenance significantly improved OS in those patients in our series who tolerated the treatment.…”

Posttransplant maintenance therapy in multiple myeloma: the changing landscape

“…It is postulated that the depth of response to primary therapy is associated with improved outcomes, particularly in the setting of ASCT. 9 Furthermore, achievement of complete response and in particular a minimal residual disease-negative state after autologous hematopoietic stem cell transplantation may translate into improved progression-free survival (PFS) and even overall survival (OS). 10, 11, 12, 13, 14 Two different approaches have been developed to pursue treatment after induction therapy: consolidation and maintenance therapy.…”

“…9 Ideal agents for maintenance are those that are easily administered (for many, this entails being an oral drug) and induce minimal toxicity while maintaining the initial response to upfront therapy. Herein we look at the current data regarding maintenance therapy and discuss the newer emerging agents that may be incorporated in future posttransplant treatment strategies.…”

Cell therapy for orofacial bone regeneration: A systematic review and meta‐analysis

“…Adult or postnatal stem cells represent promising candidates for regenerative therapy, since they have the potential to replicate in an undifferentiated state as well as to differentiate along committed lineages. Although adult stem cells are utilised in the clinic since many decades as haematopoietic stem cell (HSC) therapy through bone marrow transplantation (Mohty, Richardson, McCarthy, & Attal, ), more recently, a multipotent population of mesenchymal stromal or “stem” cells (MSCs) was identified in the non‐haematopoietic fraction of bone marrow (Friedenstein, Chailakhjan, & Lalykina, ). These MSCs have been defined by various characteristics, such as plastic adherence, self‐renewal or colony forming unit (CFU)‐potential, stromal phenotype and surface marker expression (CD73 + CD90 + CD105 + CD34 − CD45 − HLA‐DR − ), and the ability to differentiate into at least three stromal lineages, that is bone, fat and cartilage (Dominici et al., ).…”