TY - JOUR
T1 - IMWG consensus on maintenance therapy in multiple myeloma
AU - Ludwig, Heinz
AU - Durie, Brian G.M.
AU - McCarthy, Philip
AU - Palumbo, Antonio
AU - San Miguel, Jésus
AU - Barlogie, Bart
AU - Morgan, Gareth
AU - Sonneveld, Pieter
AU - Spencer, Andrew
AU - Andersen, Kenneth C.
AU - Facon, Thierry
AU - Stewart, Keith A.
AU - Einsele, Hermann
AU - Mateos, Maria Victoria
AU - Wijermans, Pierre
AU - Waage, Anders
AU - Beksac, Meral
AU - Richardson, Paul G.
AU - Hulin, Cyrille
AU - Niesvizky, Ruben
AU - Lokhorst, Henk
AU - Landgren, Ola
AU - Leif Bergsagel, P.
AU - Orlowski, Robert
AU - Hinke, Axel
AU - Cavo, Michele
AU - Attal, Michel
PY - 2012/3/29
Y1 - 2012/3/29
N2 - 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/eventfree 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.
AB - 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/eventfree 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.
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U2 - 10.1182/blood-2011-11-374249
DO - 10.1182/blood-2011-11-374249
M3 - Review article
C2 - 22271445
AN - SCOPUS:84859196307
SN - 0006-4971
VL - 119
SP - 3003
EP - 3015
JO - Blood
JF - Blood
IS - 13
ER -