Are maintenance and continuous therapies indicated for every patient with multiple myeloma?

ABSTRACT

Maintenance therapy after autologous stem cell transplantation, as well as continuous regimens for older, transplant ineligible patients, are emerging as an effective strategy to control the minimal residual disease that persists after response to initial treatments and is the main cause of relapse in patients affected by multiple myeloma (MM). However, though such approaches have consistently demonstrated in clinical trials to be able to delay disease recurrence, thus improving progression-free survival and, at least in some studies, overall survival, the use of these long term therapies (LTTs) in the daily clinical practice is not uniformly applied and some questions remains unanswered. This article aims to provide a synthetic discussion of the most consistent data on novel agent-based LTTs in newly diagnosed MM, to recognize the best candidate for these treatments and to describe a landscape of their possible future application.

KEYWORDS:

• Multiple myeloma
• maintenance therapy
• continuous therapy
• minimal residual disease
• lenalidomide
• bortezomib
• thalidomide
• carfilzomib
• ixazomib
• daratumumab
• elotuzumab

Declaration of interest

P Musto was supported by Funds for Current Research from Italian Ministry of Health to IRCCS CROB. He has also received honoraria from Celgene, Janssen, Novartis, Sanofi, Amgen, BMS. V Montefusco discloses affiliations with Celgene 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.