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Wahab A, Rafae A, Faisal MS, Mushtaq K, Ehsan H, Khakwani M, Ashraf A, Rehan T, Ahmed Z, Shah Z, Khan A, Anwer F. Advances in maintenance strategy in newly diagnosed multiple myeloma patients eligible for autologous transplantation. Expert Rev Hematol 2020; 13:1333-1347. [PMID: 33078986 DOI: 10.1080/17474086.2020.1839886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Multiple myeloma (MM) lacks curative therapy. Therefore, researchers continue to conduct studies in an effort to improve progression-free survival (PFS) and overall survival (OS). Maintenance therapy (MT) after autologous stem cell transplant (ASCT) was extensively studied in the last decade and now considered a standard approach. AREAS COVERED This review evaluated the evidence and updates on various maintenance agents in newly diagnosed multiple myeloma (NDMM) after ASCT. Articles were searched on PubMed and Embase that were published in last 10 years. Both clinical trials and observational studies were evaluated. EXPERT OPINION Maintenance strategy after ASCT has consistent PFS benefit but lacks conclusive OS improvement. Lenalidomide is superior to thalidomide given reduced neurotoxicity. OS advantage is controversial for both due to inconsistent evidence. Lenalidomide may confer a PFS advantage even at lower doses due to toxicity with higher doses. Bortezomib-based maintenance has some evidence for OS benefit in high-risk MM (HRMM) and renal dysfunction. Ixazomib has preliminary promising results. Two or three drug combinations for MT are potentially safe and more effective, particularly in HRMM although data on this subject is still evolving. Efficacy of various MT regimens in terms of minimal residual disease status needs to be further investigated.
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Affiliation(s)
- Ahsan Wahab
- Internal Medicine/Hospital Medicine Department, University of Alabama at Birmingham , Montgomery, AL, USA
| | - Abdul Rafae
- Internal Medicine Residency Program, McLaren Regional Medical Center , Flint, MI, USA
| | | | - Kamran Mushtaq
- Internal Medicine/Hospital Medicine Department, Northeast Internal Medicine Associates , LaGrange, IN, USA
| | - Hamid Ehsan
- Biomedical Sciences/Biohazardous Threat Agents & Emerging Infectious Diseases Department, Georgetown University , Washington, DC, USA
| | - Maria Khakwani
- Internal Medicine Department, Anne Arundel Medical Center , Annapolis, MD, USA
| | - Afia Ashraf
- Internal Medicine Department, Lahore Medical and Dental College , Lahore, Pakistan
| | - Tayyab Rehan
- Internal Medicine Department, Allama Iqbal Medical College , Lahore, Pakistan
| | - Zahoor Ahmed
- Internal Medicine Department, King Edward Medical University , Lahore, Pakistan
| | - Zunairah Shah
- Internal Medicine Residency Program, Louis A. Weis Memorial Hospital , Chicago, IL, USA
| | - Aslam Khan
- Internal Medicine Department, Allama Iqbal Medical College , Lahore, Pakistan
| | - Faiz Anwer
- Hematology Oncology Department, Stem Cell Transplantation Multiple Myeloma Program, Cleveland Clinic , Cleveland, Ohio, USA
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