title: What is the benefit of maintenance therapy with lenalidomide or bortezomib after autologous stem cell transplantation in multiple myeloma and what is the risk of developing a secondary primary malignancy?
abstract: An otherwise healthy 60-year-old male was diagnosed with stage II multiple myeloma by the International Staging System characterized by anemia, diffuse lytic bone lesions, IgG kappa paraproteinemia, 45% bone marrow plasmacytosis and the t(4;14) by FISH and conventional cytogenetics. The patient had a very good partial remission with initial induction therapy consisting of four 3-week cycles of bortezomib 1.3 mg/m(2) IV on days 1, 4, 8, and 11 plus dexamethasone 40 mg days 1-4 (all cycles), followed by a cyclophosphamide and G-CSF mobilized melphalan 200 mg/m(2) autologous stem cell transplantation (ASCT) and experienced minimal side effects. He is doing well 60 days post-ASCT and is in a near complete remission. His oncologist recommends maintenance therapy with lenalidomide or bortezomib, but the patient is concerned about the increased risk of developing a secondary malignancy (SM), and because he has had such an encouraging response to induction therapy, he wonders if he could remain off therapy.
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Emma
authors.initials: E
authors.lastname: Scott
authors.forename: Donna
authors.initials: D
authors.lastname: Reece
mesh_terms: D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D006801:Humans; D000077269:Lenalidomide; D060046:Maintenance Chemotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D016609:Neoplasms, Second Primary / Q000473:pathology*; D011719:Pyrazines / Q000627:therapeutic use*; D012307:Risk Factors; D033581:Stem Cell Transplantation; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014182:Transplantation, Autologous
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide