title: IMWG consensus on maintenance therapy in multiple myeloma.
abstract: Maintaining results of successful induction therapy is an important goal in multiple myeloma. Here, members of the International Myeloma Working Group review the relevant data. Thalidomide maintenance therapy after autologous stem cell transplantation improved the quality of response and increased progression-free survival (PFS) significantly in all 6 studies and overall survival (OS) in 3 of them. In elderly patients, 2 trials showed a significant prolongation of PFS, but no improvement in OS. A meta-analysis revealed a significant risk reduction for PFS/event-free survival and death. The role of thalidomide maintenance after melphalan, prednisone, and thalidomide is not well established. Two trials with lenalidomide maintenance treatment after autologous stem cell transplantation and one study after conventional melphalan, prednisone, and lenalidomide induction therapy showed a significant risk reduction for PFS and an increase in OS in one of the transplant trials. Maintenance therapy with single-agent bortezomib or in combination with thalidomide or prednisone has been studied. One trial revealed a significantly increased OS with a bortezomib-based induction and bortezomib maintenance therapy compared with conventional induction and thalidomide maintenance treatment. Maintenance treatment can be associated with significant side effects, and none of the drugs evaluated is approved for maintenance therapy. Treatment decisions for individual patients must balance potential benefits and risks carefully, as a widely agreed-on standard is not established.
authors.affiliation: Department of Medicine I, Center for Oncology and Hematology, Wilhelminenspital, Vienna, Austria. heinz.ludwig@wienkav.at
authors.forename: Heinz
authors.initials: H
authors.lastname: Ludwig
authors.forename: Brian G M
authors.initials: BG
authors.lastname: Durie
authors.forename: Philip
authors.initials: P
authors.lastname: McCarthy
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
authors.forename: Jésus
authors.initials: J
authors.lastname: San Miguel
authors.forename: Bart
authors.initials: B
authors.lastname: Barlogie
authors.forename: Gareth
authors.initials: G
authors.lastname: Morgan
authors.forename: Pieter
authors.initials: P
authors.lastname: Sonneveld
authors.forename: Andrew
authors.initials: A
authors.lastname: Spencer
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Andersen
authors.forename: Thierry
authors.initials: T
authors.lastname: Facon
authors.forename: Keith A
authors.initials: KA
authors.lastname: Stewart
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.forename: Maria-Victoria
authors.initials: MV
authors.lastname: Mateos
authors.forename: Pierre
authors.initials: P
authors.lastname: Wijermans
authors.forename: Anders
authors.initials: A
authors.lastname: Waage
authors.forename: Meral
authors.initials: M
authors.lastname: Beksac
authors.forename: Paul G
authors.initials: PG
authors.lastname: Richardson
authors.forename: Cyrille
authors.initials: C
authors.lastname: Hulin
authors.forename: Ruben
authors.initials: R
authors.lastname: Niesvizky
authors.forename: Henk
authors.initials: H
authors.lastname: Lokhorst
authors.forename: Ola
authors.initials: O
authors.lastname: Landgren
authors.forename: P Leif
authors.initials: PL
authors.lastname: Bergsagel
authors.forename: Robert
authors.initials: R
authors.lastname: Orlowski
authors.forename: Axel
authors.initials: A
authors.lastname: Hinke
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.forename: Michel
authors.initials: M
authors.lastname: Attal
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic; D032921:Consensus; D003245:Consensus Statements as Topic; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007372:Interferons / Q000008:administration & dosage / Q000627:therapeutic use; D007391:International Cooperation; D060046:Maintenance Chemotherapy / Q000379:methods* / Q000592:standards; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy*; D012955:Societies, Medical / Q000331:legislation & jurisprudence / Q000458:organization & administration
chemical_list: D005938:Glucocorticoids; D007372:Interferons