Multiple Myeloma

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Explaining Maintenance Therapy

Dr. Sagar Lonial Winship Cancer Institute, Emory University

Multiple myeloma is different from a lot of other cancers because a good number of people will stay on some form of treatment. The reasoning is really good evidence shows that this so-called “maintenance therapy” is a powerful way to extend life.

Maintenance therapy often follows the initial induction therapy and stem cell transplant. The goal of this part of treatment is to keep the myeloma from coming back for as long as possible. If you’re wondering whether maintenance therapy is really necessary, the data shows that patients who take the drug in these cycles for years at a time are surviving 2.5 to 3 years longer on average.

Dr. Sagar Lonial, Chief Medical Officer at the Winship Cancer Institute at Emory University tells us about the purpose of maintenance therapy for multiple myeloma, “The premise of maintenance therapy is that we know there may be low level disease that’s still there, either at or below the level of detection with formal testing, and we want to use less intense therapy to try and keep it at bay or further reduce the burden even more.” To do so, patients take a low dose of Revlimid, a drug that puts the immune system on guard, at a slightly amped up state, so that any cancer that appears can be quickly detected and attacked.

According to Lonial, “Revlimid is given at a dose that is much lower than we use for patients with newly diagnosed myeloma, because our goal with maintenance is not just to suppress and improve long term outcomes, but also to let patients get back to their lives.” Ultimately, there isn’t a need to continue with very intensive therapy, because doing so will just increase the severity of side effects without added benefit. “We don’t want to be continuing with really highly intensive therapy in a patient that’s going to have a really good long term outcome, just because we can. If we can reduce the intensity of therapy, that makes life a lot better for patients.”

There are still some side effects associated with maintenance therapy, but they start out as very mild. “particularly in the first year or so, the side effects tend to be relatively manageable — maybe some fatigue.” However, according to Lonial, side effects can worsen the longer you’re on maintenance. “The longer you’re on Revlimid, the more likely you are of developing some form of chronic G.I. disurbances.” But even, “that can also be managed with additional medications.” Ultimately the goal for maintenance therapy is “that [people] forget about having myeloma except when they take that pill.”

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Dr. Sagar Lonial is the Chief Medical Officer at Winship Cancer Institute of Emory University. Read More

Multiple Myeloma: Maintenance Treatment

In some cases, multiple myeloma patients will be put on something called maintenance therapy after initial treatment, in order to “maintain” myeloma in a depleted state.