In a nutshell
This article was carried out to analyze trials carried out in order to assess the role of maintenance therapy in transplant-ineligible (TI) patients with multiple myeloma (MM) following induction therapy. The authors found that maintenance therapy increases survival without disease worsening in these patients.
Some background
MM is a form of cancer that originates from plasma cells (a form of white blood cell). This usually results in other normal cells of the bone marrow not working properly. MM is usually diagnosed in older patients. Despite new therapies being developed MM remains incurable.
The use of long term therapy or maintenance therapy in MM can control the disease by stopping the progression of the cancer and provide symptom control. Maintenance therapy is recommended to keep the cancer from coming back in patients who have had a stem cell transplant (SCT). Many patients are not eligible for a SCT (TI patients) due to old age or other serious medical conditions. The use of long-term therapy in these patients may cause problems due to the risk of side effects and drug toxicity. Previous studies have not assessed the role of maintenance therapy in TI patients to this date.
Methods & findings
There were a total of 5 trials analyzed for this study. A total of 1139 TI patients were included. 612 patients received maintenance therapy group (MG). There were 527 patients in the observation (control) group (OG). The range of follow-up across the studies was 12.9-31.0 months. Four of the studies used lenalidomide (Revlimid) as maintenance therapy. One study used ixazomib (Ninlaro) as maintenance therapy.
Maintenance therapy prolonged survival without cancer worsening by 52% compared to the OG. However, there was no difference in overall survival between the MG and the OG.
Patients receiving maintenance therapy had a 3.67 times higher risk of blood-related side effects compared to the OG. They also had a 2.21 times higher risk of infections than the OG. Patients in the MG also had a 46% higher risk of developing a second cancer when compared to the OG.
The bottom line
The authors concluded that survival without cancer worsening was increased in TI patients with MM receiving maintenance therapy compared to an observation only approach. However, this comes with an increased risk of side effects.
The fine print
More studies are needed to determine which patients may benefit most from maintenance therapy.
Published By :
European Journal of Haematology
Date :
Jul 24, 2020
