Dr. Vij on Maintenance and Consolidation in Newly Diagnosed Multiple Myeloma

Ravi Vij, MD, MBA, professor of medicine, Division of Oncology, Section of Bone Marrow Transplant, Washington University School of Medicine, Siteman Cancer Center, discusses the use of maintenance and consolidation in multiple myeloma.

Post-transplant, maintenance therapy is the standard, says Vij. Most patients get lenalidomide (Revlimid) as maintenance therapy, though that may not be sufficient for high-risk patients. Patients who have deletion of 17p or other chromosome abnormalities like t(14;20) or t(14;16) may benefit from the addition of a proteasome inhibitor. Some clinicians are using dual maintenance, but there are no randomized data to suggest that it is a superior approach.

Consolidation is also being explored, though it remains experimental, explains Vij. While a the STAMINA trial failed to demonstrate a benefit in progression-free survival (PFS) with consolidative therapy, a trial done by the European Myeloma Network showed an improvement in PFS with consolidative therapy. The contradictory results may be predicated on the regimens that were used prior to transplant, says Vij. Though consolidation is not part of routine management, some investigators and treating physicians are using it in patients who do not achieve a very good partial response to deepen response post-transplant.