What is Maintenance Therapy?
- Maintenance therapy is treatment you get after a stem cell transplant for multiple myeloma.
- The drug Revlimid is the primary maintenance therapy used today.
- People with high-risk genetic changes may need to add one or more drugs to this therapy.
"I think maintenance remains a very hot topic in patients with multiple myeloma," Dr. Sumit Madan tells SurvivorNet. He's a multiple myeloma specialist at Banner MD Anderson Cancer Center in Arizona.
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People with high-risk gene changes may need more than Revlimid to improve their survival. "In patients with high-risk features, we also add a proteasome inhibitor," Dr. Madan says.Proteasomes destroy extra proteins that build up in a cell when they're not needed. Getting rid of these proteins helps cells survive. By blocking proteasomes, proteasome inhibitors speed the death of multiple myeloma cells.
Doctors treat multiple myeloma with the proteasome inhibitors bortezomib (brand name: Velcade) or carfilzomib (brand name: Kyprolis). There is also some evidence that ixazomib (brand name: Ninlaro) might be an effective maintenance drug.
Risk of Relapse
Many people with multiple myeloma do well on maintenance therapy for many years. Others have a return of symptoms called a relapse.
Your doctor will monitor you for relapse during maintenance treatment. You'll get regular blood tests and imaging tests such as MRI and X-ray. Let your treatment team know if you have any new pain or other symptoms while you're on maintenance therapy.
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If you do relapse, your doctor might change your treatment plan or add another medication. Or you might need another stem cell transplant.
Room For Improvement
Maintenance treatment could use some improvement, Dr. Madan says. A few clinical trials are studying ways to improve survival.
A study called Cassiopeia has looked at the possible benefits of adding the drug daratumumab (brand name: Darzalex) to maintenance therapy. The study showed that adding this drug helps people live longer without their cancer growing.
Future studies will help to answer other questions about maintenance therapy, such as:
- Could adding another drug improve responses and survival?
- Could adding another drug help people get off maintenance treatment sooner?
Finding the Best Treatment for You
For now, your doctor will recommend the best maintenance treatment for you based on the current science.
One way to try a new treatment before it's approved for everyone is to enroll in a clinical trial. A new treatment might be more effective than the one that's currently available.
Ask your doctor if one of these studies might be right for you. You can also search for multiple myeloma clinical trials on ClinicalTrials.gov.
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