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IMS 2026 | Optimizing maintenance strategies in multiple myeloma
Heinz Ludwig, MD, Wilhelminen Cancer Research Institute, Vienna, Austria, discusses findings from an EMN network meta-analysis evaluating maintenance strategies in multiple myeloma. He highlights evidence supporting combination maintenance, particularly daratumumab plus lenalidomide and carfilzomib-based regimens, over lenalidomide alone, with treatment intensity and duration potentially guided by disease risk and measurable residual disease status. This interview took place at the 23rd International Myeloma Society (IMS) Annual Meeting in Glasgow, UK.
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Transcript
Lenalidomide is an excellent maintenance therapy. It was the maintenance therapy that has been used in the past. But nowadays our meta-analyses showed that combinations are superior, in particular daratumumab and lenalidomide, KRd, and KR. So we now have combinations which should be used particularly in high-risk patients, but they are also beneficial to standard-risk patients. So the old dogma will be changed and we will use doublets or even triplets in certain instances...
Lenalidomide is an excellent maintenance therapy. It was the maintenance therapy that has been used in the past. But nowadays our meta-analyses showed that combinations are superior, in particular daratumumab and lenalidomide, KRd, and KR. So we now have combinations which should be used particularly in high-risk patients, but they are also beneficial to standard-risk patients. So the old dogma will be changed and we will use doublets or even triplets in certain instances. So that’s the main message. And the question is, how long should the maintenance be given? This is an open question. It depends on the individual situation. If you have a patient who is in sustained MRD negativity, who has standard risk, probably most of us will agree that they can stop after two years of maintenance. But the picture is completely different in patients with high-risk cytogenetics or in patients who are not MRD negative. So then most of our colleagues recommend continuing with maintenance therapy with doublets or in certain instances also with triplets. So that is the main message.
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