The question of drug combinations for consolidation and maintenance for multiple myeloma

Laurent Garderet, MD of Saint-Antoine Hospital, Paris, France gives an overview of his talk autologous hematopoietic stem cell transplantation (HSCT) and drug combinations for multiple myeloma (MM) at the 2016 EBMT International Transplant Course (EBMT-ITC) in Barcelona, Spain. Dr Garderet points out that major improvements have been made in treatment of myeloma but autologous stem cell transplantation remains a gold standard to treat any myeloma patient as long as they are physically fit. Now, new drugs that have been developed in the last 15 years, are given before and right after the transplant (consolidation) and further, as a maintenance treatment to prolong the response. The focus of the talk was on the question of ‘what are the best combinations for consolidation and maintenance’. Dr Garderet explains that the backbone of the drug combinations is a proteasome inhibitor plus IMiD plus a steroid. In Europe, the standard is the combination of bortezomib plus thalidomide plus dexamethasone and in the US, the combinations of cyclophosphamide, bortezomib plus dexamethasone as well as bortezomib, lenalidomide and dexamethasone are used. And in the near future, carfilzomib pus lenalidomide plus dexamethasone (KRd) will be available. With any one of these drug combinations at induction and if added to the consolidation phase, the outcome is excellent according to Dr Garderet. A burning question is the maintenance – should we do maintenance and how long. This is not answered yet. Dr Garderet points out that lenalidomide is a good drug in maintenance and he discusses the meta-analysis on lenalidomide maintenance presented at ASCO 2016. Therfore, a maintenance phase with lenalidomide may be added to this line of treatment in future.

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