How Does Maintenance Therapy for Multiple Myeloma Work?

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Maintenance Therapy for Multiple Myeloma

Maintenance therapy is meant to keep multiple myeloma under control after you’ve had other forms of treatment. It can look different from person to person.
According to one of our experts, studies of maintenance therapy for patients who have had autologous stem cell transplantation suggest that Revlimid shows the most benefit.
Some patients will be on maintenance therapy for a couple years, and others will be on it for as long as the myeloma is under control.

It’s important to remember that although multiple myeloma doesn’t technically have a “cure,” there are many people who live long, happy lives after treatment. Maintenance therapy is the last stage of multiple myeloma treatment meant to keep the cancer under control after you’ve had other forms of treatment.

Dr. Tareq Al Baghdadi, a medical oncologist and hematologist at St. Joe's Mercy Hospital in Ann Arbor, Michigan, talked with SurvivorNet about how this phase of treatment works and what drugs are used.

“With regards to maintenance therapy in multiple myeloma patients, this is mainly studied in patients who have had autologous stem cell transplantation, and there’s been multiple clinical trials looking at different medications over the years,” Dr. Al Baghdadi said. “And the one that showed the most benefit and considered standard of care at this time is Revlimid. This is especially the case in standard-risk patients who can go on two years of Revlimid, and, with that, achieve an improvement in disease control and survival.”

Maintenance therapy is also used in some patients who have not had stem cell transplants and the amount of time a person is on the drugs will depend on their individual disease and any progression.

Revlimid is the brand name for the immunomodulatory drug lenalidomide. An immunomodulatory drug is used to modify a person’s immune system response. Revlimid, in particular, is also commonly seen as part of a multiple myeloma patient’s induction therapy which occurs prior to maintenance therapy.

What are the Options?

But Revlimid is not the only maintenance therapy drug option. For high-risk multiple myeloma patients, for example, Dr. Al Baghdadi has seen that another drug can be a suitable option.

“The quality of the data in [higher-risk] patients is not as good as the data with Revlimid, but data in high risk patients also show that a drug like Velcade can improve disease control and survival,” he said. “So you’ll see some patients going on maintenance with Velcade and occasionally with both drugs, Velcade and Revlimid.”

Dr. Al Baghdadi also explained that maintenance therapy does not have a specific time limit. Some patients are only on a certain medication(s) for a couple years and others are on it/them indefinitely, and there are ongoing trials right now working to compare two years of maintenance therapy versus maintenance therapy until progression meaning continued use of the drug(s) for as long as the myeloma is under control. No matter what, you should talk with your doctor and explore your options. Remember, maintenance therapy like most any cancer treatment is not a one size fits all.

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