STEP 7: Consolidation and maintenance
Maintenance, also called “continuous therapy,” is a treatment that is administered over a long period of time, typically years, in an effort to sustain or enhance response which has already been achieved with prior therapy. The therapy can be different or the same as prior therapy, but dosages are adjusted to achieve and sustain long-term efficacy and tolerance.
Consolidation is a related type of treatment, used most commonly within clinical trials. It is administered after a course of therapy over days or weeks to achieve further reduction in myeloma tumor burden. Consolidation is not a “standard of care” approach to myeloma therapy.
Consolidation or maintenance therapy is each a way to achieve a better response. The benefits need to be discussed on an individual basis, and be balanced against quality-of-life and cost issues.
Clinical trials have shown benefits with several types of maintenance, including older drugs such as steroids and alpha-interferon, as well as more recent therapies. The French myeloma group’s FIRST trial demonstrated that continuous therapy with Revlimid improves overall survival compared to MPV or a fixed dose of 18 months of Revlimid in non-transplant-eligible patients. A meta-analysis of data from three post-ASCT maintenance therapy trials with Revlimid demonstrated that Revlimid significantly prolonged overall survival, including in patients who achieved CR, and provided benefit to transplant patients in all response categories.
Maintenance or continuous therapy is standard of care
- Responses tend to deepen with additional cycles of therapy
- PFS and OS benefits seen with maintenance/continuous therapy
- After ASCT, R maintenance increased OS, PFS
- Continuous therapy produced increased PFS
* ASCT = autologous stem cell transplant; OS = overall survival; PFS = progression-free survival; R = Revlimid® (lenalidomide)
Hulin C, et al. ASH 2014 #81; Facon T, et al. ASH 2013 #2; Palumbo A, et al. NEJM. 2014; 371(10):895-905; Attal et al. ASH 2015 #319; Lentzsch S, et al. ASH 2015 #1975.