Developments in consolidation and maintenance strategies in post-remission multiple myeloma

ABSTRACT

Introduction: Multiple Myeloma (MM) is a very heterogeneous clonal plasma cell hematological malignancy for which new therapies and transplantation effectively improve Progression-free survival (PFS) and overall survival (OS). Maintenance seems to have made a significant contribution in achieving these advances, whereas the real role of consolidation is still controversial. Despite lenalidomide having been approved as maintenance therapy after autologous stem cell transplantation (ASCT), the optimal maintenance agent, drug combinations, schedules, and duration are still under investigation.

Areas covered: This review summarizes data regarding maintenance and consolidation therapies for transplant-eligible patients, updating on the ongoing developments in this area. Papers published on PubMed and abstracts presented at the ASCO, ASH, and EHA meetings up to December 2019 were used.

Expert opinion: The available studies demonstrate that maintenance therapy is very effective although results from ongoing clinical trials suggest that disease features and minimal residual disease (MRD) status may optimize the selection of agents, schedule, and duration of maintenance therapy. Consolidation with last-generation drugs seems to be more effective and it could replace transplantation in some subgroups of patients.

KEYWORDS:

• Multiple myeloma
• consolidation
• maintenance
• lenalidomide
• bortezomib
• carfilzomib
• minimal residual disease

Article Highlights

• Therapeutic modalities such as consolidation or maintenance that allow to achieve and maintain maximal response is now the standard of care in most MM patients.

• Lenalidomide post-transplant maintenance therapy is now the established standard of care for standard-risk MM patients.

• Risk-adapted drug combinations and duration of post-transplant maintenance therapy is under active investigation.

• Post-transplant consolidation data are controversial, but the latest data are very encouraging.

Declaration of Interest

S Morè receives honoraria from Amgen; M Offidani receives homorari and is on the advisory board for Amgen, BMS, Celgene, Janssen, Sanofi, and Takeda; L Corvatta receives honoraria from Amgen and Janssen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.