Maintenance Therapy for Multiple Myeloma
- Maintenance therapy involves taking a low dose of medication for a long period of time.
- You’ll get this treatment after induction therapy and a stem cell transplant.
- The typical maintenance therapy is with the drug Revlimid.
- Testing for very small amounts of cancer, called minimal residual disease, can help fine-tune your treatment.
Maintenance therapy involves taking a lower dose of medication for a long period of time. This treatment doesn't cure multiple myeloma. But it could keep you in remission longer and delay a relapse.
Types of Maintenance Therapy
Read MoreSome research finds that taking Revlimid after an autologous stem cell transplant doubles survival compared to placebo (sugar pill). And it helps people live longer without their cancer progressing.
Maintenance Therapy for High-Risk Myeloma
Some people with multiple myeloma have certain gene changes that make their cancer more difficult to treat. Doctors call this high-risk multiple myeloma.
If your cancer is high-risk, Revlimid alone might not be enough to control it. Your doctor might add bortezomib (Velcade) or other drugs or other two-drug combinations. Velcade is a type of medication called a proteasome inhibitor. It blocks enzymes from breaking down unneeded proteins in cancer cells. This disrupts the cells' normal activities, which stops them from dividing and causes them to die.
Some doctors use another proteasome inhibitor, such as carfilzomib (Kyprolis). And they might add a steroid to help control side effects from treatment.
Why Minimal Residual Disease (MRD) Matters
One of the newer strategies for maintenance therapy involves minimal residual disease (MRD) testing. Residual disease means that you still have a very small number of myeloma cells left in your bone marrow after treatment.
RELATED: How to Decide Which Maintenance Drug to Be On
These cells might be so small that they don't cause symptoms and even a microscope can't spot them. But without more treatment they could grow and cause a relapse.
Your doctor will test your MRD status by taking a sample from your bone marrow. "We use the original bone marrow biopsy and we isolate a myeloma cell," Dr. Gowin says. "We say, what are the genetic features of that myeloma cell? And then we use that information to go looking for that same sequence."
What Your MRD Test Results Mean
If the test does find the same sequence, you're MRD-positive. That means you have some cancer cells left over. MRD-negative means that the test detected no myeloma cells.
If you are MRD-positive, you might need more intense maintenance treatment. More precise medications target specific gene mutations in the cancer cells.
Clinical trials are looking at the best ways to use MRD testing. Researchers want to learn how this test might help determine the intensity and length of maintenance treatment, Dr. Gowin says.
How Long Should You Stay on Maintenance Therapy?
There's some debate about the ideal length of maintenance therapy. In Europe, the treatment has a fixed end point. That's usually two to three years. But many doctors in America keep patients on maintenance therapy until their cancer starts to grow again (called progression).
So that you won't have any surprises, ask your doctor a lot of questions when you start maintenance therapy. "My recommendation would be to have an open conversation," Dr. Gowin says.
RELATED: A Guide to Managing a Multiple Myeloma Relapse
Find out why your doctor has recommended the treatment. Ask what kinds of side effects you might experience. Learn how often you'll need to come in for testing while you're on the medication, and how long your treatment might last.
Dr. Gowin also recommends getting a second opinion. Seek out a multiple myeloma specialist at a major cancer center. See what they think about your MRD status and maintenance therapy options. And find out if you’re eligible for any clinical trials.
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