Explaining Maintenance Therapy for Multiple Myeloma
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/ Updated February 4th, 2022

Explaining Maintenance Therapy for Multiple Myeloma

Medically Reviewed: Dr. Joshua Richter Written by: Sydney Schaefer
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Understanding Maintenance Therapy for Multiple Myeloma

  • Once you have been through the first two phases of treatment for multiple myeloma, the next step is called maintenance therapy.
  • The term "maintenance therapy" means the treatment is aiming to keep the patient in a state of remission.
  • The standard of care for multiple myeloma maintenance therapy is immunotherapy drug lenalidomide (brand name: Revlimid). This drug is also given during the induction therapy phase in combination with other drugs.
Once you have been through the first two rounds of treatment for multiple myeloma induction therapy with drug combinations and stem cell transplant, if eligible the next step in order to make sure the cancer does not return is called maintenance therapy.

Dr. Dickran Kazandjian, a multiple myeloma specialist at the Sylvester Comprehensive Cancer Center in Miami, Fla., has called other terms, such as "induction therapy," for treating myeloma "misnomers." However, he says that maintenance therapy is the only term in multiple myeloma treatment that actually makes sense, as doctors are literally trying to maintain a patient's remission.

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The term "maintenance therapy" also lends itself to the fact that multiple myeloma is not a curable disease; doctors are able to treat their patients and send them into remission. This is called MRD negative, which means that no disease was detected after treatment.

RELATED: Are There Options for Maintenance Therapy?

However, there is always a chance that the disease will come back. So, with maintenance therapy, your doctor is trying to maintain your remission for as long as possible. But Dr. Kazandjian says that there is a chance patients can live MRD negative for quite some time with proper maintenance therapy.

"Technically, myeloma is not a curable cancer, but all of us have had patients that, at least what we think, are in a functional cure," Dr. Kazandjian tells SurvivorNet. "I'm talking about people who got a few years of maintenance and are MRD negative off treatment now for years"

"It's rare," he adds. "It's not the rule, but it happens."

What Drugs Should Patients Take During Maintenance Therapy?

Right now, the standard of care for multiple myeloma maintenance therapy is immunotherapy drug lenalidomide (brand name: Revlimid). This drug is also given during the induction therapy phase in combination with other drugs in order to get the deepest remission possible.

With continued treatment with lenalidomide, the maintenance therapy phase has proven effective in keeping multiple myeloma at bay for long stretches of time, as Dr. Kazandjian alluded to.

RELATED: Monitoring Disease Progression During Maintenance Therapy

In Miami, Dr. Kazandjian says he and his colleagues generally agree that lenalidomide is the way to go when it comes to maintenance therapy.

"Most of us at our center (in Miami) believe in still doing lenalidomide maintenance," he says, adding that there is some disagreement among other multiple myeloma specialists when it comes to which drug is the best to use during this treatment phase.

"I think there are some folks (who) believe that giving potentially more maintenance therapies … for high-risk disease may help," he says.

One of those maintenance therapies Dr. Kazandjian speaks of is proteasome inhibitor carfilzomib (brand name: Kyprolis), which is also a drug that is given during the induction therapy phase in combination with other drugs.

"I don't think we're so convinced about that fact."

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Patient Pathfinder

We’re here to help. Have you had any treatment for myeloma yet?

You might want to check out some top experts outlining the initial treatment for myeloma.

Here’s the link:


Multiple Myeloma Initial Treatment

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Got it. Are you looking for maintenance treatment?

You might want to check out some top experts outlining maintenance treatment for myeloma.

Here’s the link:


Multiple Myeloma Maintenance Treatment

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Ok. Has your Myeloma come back? Here are some useful resources:

Here’s the link:


Multiple Myeloma Reoccurrence Treatment

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If you’ve had at least four treatments that have not worked or stopped working you might be a candidate for a treatment called CAR T Therapy.

Here’s the link:


CAR-T Therapy for Multiple Myeloma

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