Evolving role of novel agents for maintenance therapy in myeloma.
Maintenance therapy after remission achievement is a question still open in multiple myeloma (MM). Steroids and interferon-alpha failed to demonstrate a clear benefit in term of survival. Thalidomide, lenalidomide, and bortezomib have shown to be effective and safe drugs for the treatment of both newly diagnosed and relapsed MM, leading to explore their efficacy also in maintenance setting. Thalidomide seems to be a good choice for patients with low-risk MM and for those who achieved less than very good partial remission after induction treatment. Lenalidomide and bortezomib are still under investigation and a longer follow-up is needed for confirming their role as maintenance treatment. As shown by recent clinical trials, thalidomide and bortezomib are more indicated as consolidation agent, increasing the complete remission/very good partial remission rate. Considering their toxicity profile, first of all peripheral neuropathy and, in case of thalidomide, the lack of correlation between cumulative dose and outcome, a limited administration is suggested. In contrast, lenalidomide showed a low toxicity profile and a benefit from prolonged treatment, making the drug one of the best choices for maintenance treatment.
Magarotto
Valeria
V
Divisione Universitaria di Ematologia, Az Ospedaliera S. Giovanni Battista, via Genova 3, 10126 Torino, Italy. magotta81@hotmail.com
Palumbo
Antonio
A
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D000077269:Lenalidomide; D008558:Melphalan / Q000627:therapeutic use; D009101:Multiple Myeloma / Q000188:drug therapy*; D011239:Prednisolone / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000627:therapeutic use; D011719:Pyrazines / Q000627:therapeutic use*; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D018906:Antineoplastic Agents, Alkylating; D018931:Antineoplastic Agents, Hormonal; D001897:Boronic Acids; D011480:Protease Inhibitors; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D003907:Dexamethasone; D011239:Prednisolone; D000077269:Lenalidomide; D008558:Melphalan