IMWG consensus on maintenance therapy in multiple myeloma.

Abstract

Maintaining results of successful induction therapy is an important goal in multiple myeloma. Here, members of the International Myeloma Working Group review the relevant data. Thalidomide maintenance therapy after autologous stem cell transplantation improved the quality of response and increased progression-free survival (PFS) significantly in all 6 studies and overall survival (OS) in 3 of them. In elderly patients, 2 trials showed a significant prolongation of PFS, but no improvement in OS. A meta-analysis revealed a significant risk reduction for PFS/event-free survival and death. The role of thalidomide maintenance after melphalan, prednisone, and thalidomide is not well established. Two trials with lenalidomide maintenance treatment after autologous stem cell transplantation and one study after conventional melphalan, prednisone, and lenalidomide induction therapy showed a significant risk reduction for PFS and an increase in OS in one of the transplant trials. Maintenance therapy with single-agent bortezomib or in combination with thalidomide or prednisone has been studied. One trial revealed a significantly increased OS with a bortezomib-based induction and bortezomib maintenance therapy compared with conventional induction and thalidomide maintenance treatment. Maintenance treatment can be associated with significant side effects, and none of the drugs evaluated is approved for maintenance therapy. Treatment decisions for individual patients must balance potential benefits and risks carefully, as a widely agreed-on standard is not established.

• Authors: Heinz Ludwig, Brian G M Durie, Philip McCarthy, Antonio Palumbo, Jésus San Miguel, Bart Barlogie, Gareth Morgan, Pieter Sonneveld, Andrew Spencer, Kenneth C Andersen, Thierry Facon, Keith A Stewart, Hermann Einsele, Maria-Victoria Mateos, Pierre Wijermans, Anders Waage, Meral Beksac, Paul G Richardson, Cyrille Hulin, Ruben Niesvizky, Henk Lokhorst, Ola Landgren, P Leif Bergsagel, Robert Orlowski, Axel Hinke, Michele Cavo, Michel Attal, International Myeloma Working Group
• Journal: Blood (Blood) Vol. 119 Issue 13 Pg. 3003-15 (Mar 29 2012) ISSN: 1528-0020 [Electronic] United States
• PMID: 22271445 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Glucocorticoids
• Interferons

Topics

• Animals
• Clinical Trials as Topic
• Consensus
• Consensus Development Conferences as Topic
• Glucocorticoids (administration & dosage, therapeutic use)
• Humans
• Interferons (administration & dosage, therapeutic use)
• International Cooperation
• Maintenance Chemotherapy (methods, standards)
• Multiple Myeloma (drug therapy, therapy)
• Societies, Medical (legislation & jurisprudence, organization & administration)