Maintenance Therapy for Patients With Multiple Myeloma

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Maintenance therapy plays a role in hematologic malignancies such as non-Hodgkin’s lymphoma and has become a standard of practice for patients with multiple myeloma. In this segment, Noopur Raje, MD, Sagar Lonial, MD, and Ann McNeill, RN, APN, discuss maintenance therapy and its use in the management of patients with multiple myeloma.

Lonial explains that clinicians consider a variety of factors before deciding which maintenance therapy option is appropriate, including risk level and transplant status For standard-risk post transplant patients he recommends a single agent, lenalidomide, and for high-risk patients, lenalidomide, bortezomib, and dexamethasone triple combination therapy. The results of genetic testing and previous treatment regimens are additional important factors that are considered when deciding on a medication option and an appropriate duration of maintenance therapy. Lonial uses a bortezomib-based maintenance approach in patients with a t(4;14) translocation or those who present as relatively insensitive to immunomodulatory drugs.

Raje remarks that in her practice, she recommends indefinite maintenance therapy Various agents are used, including lenalidomide and bortezomib. She notes that although the duration of treatment is highly debatable, evaluating minimal residual disease status can help determine the appropriate length of treatment with maintenance therapy.

McNeill explains the key roles nurses play in the clinical management of multiple myeloma, and the variables that nurses consider when monitoring disease progression and toxicities from treatment. It is important to educate patients regarding dosing schedules and adverse reactions.