Current Status of Maintenance Therapy in Multiple Myeloma

Abstract

Despite the introduction of autologous hematopoietic stem cell transplant (AHSCT) and novel agents, myeloma is considered to be incurable. The majority of patients will have disease progression or relapse at some point after AHSCT or after the initial front-line therapy. The depth and duration of the response achieved after AHSCT or front-line therapy is closely related to the long-term outcomes. Trying to develop strategies in order to prevent or delay disease progression or relapse has resulted in the concepts of consolidation or maintenance. Initial maintenance attempts with single agent corticosteroids, interferon-〈, conventional chemotherapies, or a combination of these agents have shown a variably prolonged progression-free survival (PFS) but no benefit to overall survival (OS) with high toxicity rates. Maintenance approaches with a prolonged course of novel agents have improved PFS and OS to a certain degree with tolerable drug-related toxicities. Despite contradictory data, maintenance therapy with novel agents can be a reasonable approach for those patients who have failed to achieve at least very good partial response (VGPR) after AHSCT or front-line therapy, or for the patients presented with high-risk disease based on genetic abnormalities as well as other laboratory features. Here, we review the available data on the various maintenance strategies that have been evaluated in the setting of myeloma.