Almost all oncologists administer maintenance treatment for elderly patients, usually (as with the faculty) after maximal response is observed. The FIRST trial used two approaches to Rd, one for a fixed duration of 18 cycles and the other indefinitely, which was the randomization arm with the best results. Dr Vij treats indefinitely, but for older patients receiving bortezomib he generally limits maintenance to 1 year, particularly because of the
inconvenience of parenteral administration. Dr Munshi notes that the recent emergence of oral proteasome inhibitors such as ixazomib and oprozomib may dramatically alter the landscape for proteasome maintenance therapy in the future.

McCarthy P et al. Lenalidomide after stem-cell transplantation for multiple myeloma. N Engl J Med 2012;366(19):1770-81. Abstract

Palumbo A et al. Continuous lenalidomide treatment for newly diagnosed multiple myeloma. N Engl J Med 2012;366(19):1759-69. Abstract

Benboubker L et al. Lenalidomide and dexamethasone in transplant-ineligible patients with myeloma. N Engl J Med 2014;371(10):906-17. Abstract