Maintenance therapy is given after initial treatment for multiple myeloma. It aims to control your cancer and prevent progression. The type of maintenance therapy you receive depends on whether your disease is standard risk or high risk.
There are different stages of treatment of MM. One of these is maintenance therapy, which is sometimes given after your initial treatment.
Keep reading to learn more about maintenance therapy for MM, the available options, and their side effects.
The initial treatment of MM typically involves a course of drug therapy. This may be followed by a stem cell transplant, depending on factors like your age, overall health, and how advanced your MM is.
Maintenance therapy is a course of treatment that’s given after your initial treatment has concluded. It has two goals:
- to keep the growth of cancer cells suppressed after initial treatment
- to prevent the progression of MM
In an ideal situation, maintenance therapy is continued long-term until your MM progresses. However, in some cases, it may be discontinued due to side effects.
As such, researchers continue to investigate different drug combinations that can be used in maintenance therapy. The goal is to find a regimen that keeps your MM in remission and prevents progression while causing the fewest side effects.
There are a couple of drug regimens that are commonly used for MM maintenance therapy. Which one is recommended to you can depend on whether or not your MM is standard risk or high risk.
Having certain chromosome abnormalities often determines your risk status. However, other factors may also play a role, such as the stage of your MM, the presence of disease outside of the bone marrow, and your overall health.
Generally speaking, people with high risk MM tend to have more aggressive disease and poorer outcomes. Because of this, their treatment needs can be different from those with standard risk MM.
Maintenance therapy for standard risk
If you have standard risk MM, it’s likely that your maintenance therapy will involve a single drug called lenalidomide (Revlimid).
Lenalidomide is an immunomodulatory drug. This drug type can modify the activity of the immune system and also has anti-myeloma activity.
Maintenance therapy for high risk
If you have high risk MM, a proteasome inhibitor like bortezomib (Velcade) will often be used with lenalidomide.
Proteasome inhibitors block the activity of complexes called proteasomes, which are the system that a cell uses to dispose of excess or misfolded proteins. When too many “garbage” proteins accumulate in a cell, it dies.
Like any type of treatment, maintenance therapy can have a variety of side effects. Let’s explore these now.
The most common side effects of lenalidomide may include:
- feelings of fatigue or weakness
- reduced appetite
- low blood counts, which can cause anemia, increased infection risk, and easy bleeding
- difficulty sleeping
- pain in your back or abdomen
- shortness of breath
- muscle cramps
Lenalidomide in maintenance therapy is also associated with a
The most common side effects associated with bortezomib are:
Generally speaking, research has found that lenalidomide-based maintenance therapy is most beneficial. A
Compared to maintenance therapy regiments containing bortezomib, the study found that maintenance therapy with lenalidomide alone was associated with improved PFS and OS at two years.
Researchers also noted that people receiving bortezomib-based maintenance therapy were more likely to have factors associated with a poorer outlook, such as two or more high risk chromosomal abnormalities and stage 3 disease.
Maintenance therapy for MM is given after your initial treatment. Its goal is to keep your MM in remission and prevent progression.
Lenalidomide alone is typically used for maintenance in standard risk MM. If you have high risk MM, a proteasome inhibitor like bortezomib may also be used in addition to lenalidomide.
Receiving maintenance therapy long-term is associated with a variety of side effects that can lead to discontinuation. Because of this, researchers continue to investigate new drug combinations for MM maintenance therapy.