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Kawamura K. Maintenance therapy after allogeneic hematopoietic stem cell transplantation for patients with multiple myeloma. Int J Hematol 2023:10.1007/s12185-023-03602-1. [PMID: 37060508 DOI: 10.1007/s12185-023-03602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/16/2023]
Abstract
In the last two decades, proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), and monoclonal antibodies have greatly improved the overall survival of patients with multiple myeloma. However, multiple myeloma remains incurable, and high-risk patients have poor long-term survival. Although allogeneic hematopoietic stem cell transplantation (allo-HCT) is not considered standard therapy because of relatively high transplant-related mortality and relapse rates, the graft-versus-myeloma (GVM) effect makes it a potentially curative therapy. Therefore, allo-HCT remains a treatment option for younger patients and those with high-risk myeloma. Maintenance therapy with novel agents has recently been attempted to reduce relapse in patients undergoing allo-HCT, but its effectiveness remains unclear. This review focuses on the role of maintenance therapy after allo-HCT in patients with myeloma. Maintenance therapy using IMiDs and/or PIs after allo-HCT may be effective in reducing relapse or improving response because it may prevent early progression before achievement of the GVM effect or enhance the GVM effect. However, care must be taken to avoid complications, such as graft-versus-host disease. Further studies are necessary to determine the optimal maintenance drugs, drug combinations, dosing, start timing, and number of cycles.
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Affiliation(s)
- Koji Kawamura
- Division of Clinical Laboratory Medicine, Department of Multidisciplinary Internal Medicine, Tottori University, 86, Nishi-Cho, Yonago-City, Tottori, 683-8503, Japan.
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Muranushi H, Kanda J, Kobayashi M, Maeda T, Kitano T, Tsuji M, Ueda Y, Ishikawa T, Nohgawa M, Watanabe M, Imada K, Moriguchi T, Itoh M, Ohno H, Yonezawa A, Hirata H, Arima N, Asagoe K, Anzai N, Nagata K, Yasuno S, Kuwabara Y, Kitao H, Kim I, Kawagishi K, Ueshima K, Tominari S, Nakayama T, Yamashita K, Takaori-Kondo A. Bortezomib-cyclophosphamide-dexamethasone induction/consolidation and bortezomib maintenance for transplant-eligible newly diagnosed multiple myeloma: phase 2 multicenter trial. Hematology 2022; 27:239-248. [DOI: 10.1080/16078454.2022.2032915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hiroyuki Muranushi
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masayuki Kobayashi
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Hematology, Japan Baptist Hospital, Kyoto, Japan
| | - Takeshi Maeda
- Department of Haematology/Oncology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toshiyuki Kitano
- Department of Hematology, Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Masaaki Tsuji
- Department of Hematology and Immunology, Otsu Red Cross Hospital, Otsu, Japan
| | - Yasunori Ueda
- Department of Haematology/Oncology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masaharu Nohgawa
- Department of Hematology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Mitsumasa Watanabe
- Department of Hematology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kazunori Imada
- Department of Hematology, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | | | - Mitsuru Itoh
- Department of Hematology, Kyoto City Hospital, Kyoto, Japan
| | - Hitoshi Ohno
- Department of Hematology, Tenri Hospital, Tenri, Japan
| | - Akihito Yonezawa
- Department of Hematology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hirokazu Hirata
- Department of Hematology, Kansai Electric Power Hospital, Osaka, Japan
| | - Nobuyoshi Arima
- Department of Hematology, Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Kohsuke Asagoe
- Department of Hematology and Oncology, Shiga General Hospital, Moriyama, Japan
| | - Naoyuki Anzai
- Department of Hematology and Oncology, Takatsuki Red Cross Hospital, Takatsuki, Japan
| | - Kayoko Nagata
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Yasuno
- Clinical Research Support Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshihiro Kuwabara
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Hiromi Kitao
- Department of Data Science, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Ihhwa Kim
- Department of Data Science, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Kiyomi Kawagishi
- Department of Data Science, Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital, Kyoto, Japan
| | - Shinjiro Tominari
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Kouhei Yamashita
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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