title: Moving Beyond Autologous Transplantation in Multiple Myeloma: Consolidation, Maintenance, Allogeneic Transplant, and Immune Therapy.
abstract: For multiple myeloma, introduction of novel agents as part of the front-line treatment followed by high-dose chemotherapy and autologous hematopoietic stem cell transplantation (ASCT) induces deep responses in a majority of patients with this disease. However, disease relapse is inevitable, and, with each relapse, the remission duration becomes shorter, ultimately leading to a refractory disease. Consolidation and maintenance strategy after ASCT is one route to provide sustained disease control and prevent repeated relapses. Though the consolidation strategy remains largely confined to clinical trials, significant data support the efficacy of consolidation in improving the depth of response and outcomes. There are also increasing rates of minimal residual disease-negativity with additional consolidation therapy. On the other hand, maintenance with novel agents post-transplant is well established and has been shown to improve both progression-free and overall survival. Evolving paradigms in maintenance include the use of newer proteasome inhibitors, immunotherapy maintenance, and patient-specific maintenance-a concept that utilizes minimal residual disease as the primary driver of decisions regarding starting or continuing maintenance therapy. The other approach to overcome residual disease is immune therapeutic strategies. The demonstration of myeloma-specific alloimmunity from allogeneic transplantation is well established. More sophisticated and promising immune approaches include adoptive cellular therapies, tumor vaccines, and immune checkpoint manipulations. In the future, personalized minimal residual disease-driven treatment strategies following ASCT will help overcome the residual disease, restore multiple myeloma-specific immunity, and achieve sustained disease control while minimizing the risk of overtreatment.
authors.affiliation: From the Judy and Bernard Briskin Center for Myeloma, City of Hope Cancer Center, Duarte, CA; Division of Medical Oncology, Washington University School of Medicine in St. Louis, St Louis, MO; Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Amrita
authors.initials: A
authors.lastname: Krishnan
authors.affiliation: From the Judy and Bernard Briskin Center for Myeloma, City of Hope Cancer Center, Duarte, CA; Division of Medical Oncology, Washington University School of Medicine in St. Louis, St Louis, MO; Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Ravi
authors.initials: R
authors.lastname: Vij
authors.affiliation: From the Judy and Bernard Briskin Center for Myeloma, City of Hope Cancer Center, Duarte, CA; Division of Medical Oncology, Washington University School of Medicine in St. Louis, St Louis, MO; Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Jesse
authors.initials: J
authors.lastname: Keller
authors.affiliation: From the Judy and Bernard Briskin Center for Myeloma, City of Hope Cancer Center, Duarte, CA; Division of Medical Oncology, Washington University School of Medicine in St. Louis, St Louis, MO; Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Binod
authors.initials: B
authors.lastname: Dhakal
authors.affiliation: From the Judy and Bernard Briskin Center for Myeloma, City of Hope Cancer Center, Duarte, CA; Division of Medical Oncology, Washington University School of Medicine in St. Louis, St Louis, MO; Division of Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Hari
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D060046:Maintenance Chemotherapy; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D061988:Proteasome Inhibitors / Q000627:therapeutic use; D013792:Thalidomide / Q000627:therapeutic use; D014182:Transplantation, Autologous
chemical_list: D061988:Proteasome Inhibitors; D013792:Thalidomide