SUMMARY

The role of maintenance therapy in the treatment of patients with multiple myeloma is currently under extensive evaluation. Maintenance therapy is defined as the addition of chronically applied therapy, following induction in responding or stable patient, with the goal of prolonging survival (ASH:FDA Workshop). Prolonged conventional chemotherapy has not only proven to be ineffective as maintenance therapy, but it is also associated with an increased risk of secondary myelodysplastic syndromes. Interferon α and corticosteroids have also been evaluated as maintenance therapy, but these treatments demonstrated marginal benefit at the cost of excessive toxicity. Recent studies have evaluated the role of maintenance thalidomide with hints that for certain subsets there may be a significant benefit. Additional studies are ongoing, testing the combination of thalidomide and corticosteroids, lenalidomide, and bortezomib in the maintenance setting. Future studies will need to identify not only the relative benefit for these agents in the maintenance setting but also the role cytogenetic risk groups play on the relative benefit of maintenance approaches.

INTRODUCTION

Multiple myeloma is an incurable malignancy characterized by the accumulation of malignant plasma cells. Treatment options for patients with myeloma have utilized alkylator-based therapy in conjunction with corticosteroids, and more recently, the widespread use of high-dose therapy and autologous transplant has improved overall survival (OS) for many of these patients. These improvements in OS have been associated with improving the rate of complete remission, a disease state not known to be associated with a cure but with superior long-term outcomes.