Posttransplant maintenance therapy in multiple myeloma: the changing landscape

Abstract

Transplant-eligible patients with multiple myeloma (MM) now have extended survival after diagnosis owing to effective modern treatment strategies that include new agents in induction therapy, autologous stem cell transplant (ASCT), consolidation therapy and posttransplant maintenance therapy. Standard of care for newly diagnosed, fit patients includes ASCT and, often nowadays, posttransplant maintenance. Several large studies have shown the efficacy of maintenance with thalidomide, lenalidomide and bortezomib in the treatment scheme of MM with regards to prolonging progression-free survival and, to a lesser degree, overall survival. Herein we discuss the data currently available to support the use of maintenance therapy in patients after ASCT as well as the newer available agents that may be a part of its changing landscape in the years to come.

Evolution of multiple myeloma treatment practices in Europe from 2014 to 2016

“…The multiple myeloma (MM) treatment environment has expanded since the approval of bortezomib and lenalidomide. Patients are increasingly receiving multiple lines of therapy, leading to improved survival (Torimoto et al, 2015;Sengsayadeth et al, 2017).…”

Productivity losses in patients with newly diagnosed multiple myeloma following stem cell transplantation and the impact of maintenance therapy

“…Based on clinical evidence, the model assumed the rate of disease progression could be altered by patients receiving a maintenance therapy . Productivity losses for the population cohort were estimated for patients with NDMM not receiving maintenance therapy and compared with those receiving lenalidomide.…”

“…Productivity losses for the population cohort were estimated for patients with NDMM not receiving maintenance therapy and compared with those receiving lenalidomide. Lenalidomide maintenance therapy was used to inform the survival curve modelling, as it is the only maintenance therapy licensed in the EU5 countries . Losses were estimated on both a per‐patient basis over the 20‐year time horizon and as the total aggregated losses from a 1‐year incident patient cohort.…”

“…19 Based on clinical evidence, the model assumed the rate of disease progression could be altered by patients receiving a maintenance therapy. 2,7,[10][11][12] Productivity losses for the population cohort were estimated for patients with NDMM not receiving maintenance therapy and compared with those receiving lenalidomide. Lenalidomide maintenance therapy was used to inform the survival curve modelling, as it is the only maintenance therapy licensed in the EU5 countries.…”

“…Lenalidomide maintenance therapy was used to inform the survival curve modelling, as it is the only maintenance therapy licensed in the EU5 countries. 2,7,[10][11][12] Losses were estimated on both a per-patient basis over the 20-year time horizon and as the total aggregated losses from a 1-year incident patient cohort.…”