The optimal duration of lenalidomide maintenance post-autologous stem cell transplant (ASCT) in Multiple Myeloma (MM), and choice of therapy at relapse post-maintenance, need further evaluation. This retrospective study assessed outcomes of patients with MM (n = 213) seen at Mayo Clinic, Rochester b …
So this was a fascinating study that came out of Mayo Clinic this month.
The duration of maintenance following transplant in patients with multiple myeloma remains a contentious topic. The reality is that in a retrospective analysis, when patients who have been “longer” on maintenance are compared to patients who have been on maintenance “shorter” are compared, PFS is found to be longer in patients who were on lenalidomide longer. However, this again implies a difference in disease biology, and not necessarily treatment effect. Patients who were fit, and whose disease was stable enough to have stayed on lenalidomide longer obviously did better than those that werent. Nevertheless, this adds to other data, such as that from long-term follow up of STAMINA trial presented in 2020 by Hari et al, that generally the longer one is on lenalidomide maintenance, the longer the PFS, with the caveats above.
I do look forward to maturing data from ongoing trials, and levaraging MRD to discontinue indefinite maintenance, but for now- for patients who are continuing to tolerate treatment well, I tend to keep maintenance for as long as I can. For those in very deep remissions (MRD negativity) for several years, I do not think discontinuing maintenance in lieu of close monitoring will lead to a change in overall survival, although I obviously do not have definitive data to support these thoughts. Reasonable to discuss with patients in those situations and stop maintenance on a case to case basis.