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In multiple myeloma (MM), maintenance therapy is a longer and less intensive treatment course than initial therapy that is administered after induction to delay disease progression. Maintenance and continuous therapy have been shown to suppress minimal residual disease and deepen and prolong responses, with the goal of improving progression-free survival and overall survival. Areas covered: In this review, we have summarized current clinical trial data on maintenance and continuous therapy in newly-diagnosed MM and relapsed/refractory MM (RRMM), focusing on lenalidomide and bortezomib. We have also analyzed the potential uses of newer agents, including carfilzomib, daratumumab, elotuzumab, and ixazomib. Expert commentary: Although lenalidomide- and bortezomib-containing regimens have demonstrated safety and efficacy, only lenalidomide is approved for maintenance, and it is the preferred agent in the National Comprehensive Cancer Network and European Society for Medical Oncology myeloma guidelines. Furthermore, results from the FIRST trial support lenalidomide plus low-dose dexamethasone as a standard of care for continuous therapy. In RRMM, newer agents have been successfully added to lenalidomide plus low-dose dexamethasone; we await data from additional trials. The vital roles of maintenance and continuous therapy and their benefits are clearly understood, but important questions remain regarding optimal duration of therapy and regimens.
PMID: 29932776 [PubMed - as supplied by publisher]