For patients at standard risk, more than 85% of respondents and the faculty use maintenance treatment after autologous stem cell transplant, including for patients with a very good partial or a complete response (CR). The regimen choice is the same for both levels of response, almost always lenalidomide with or without dexamethasone. Dr Vij notes that prior to Phase III maintenance trials, many investigators speculated that patients in post-transplant CR would not benefit, but recent trials have demonstrated benefit in all response subsets. Dr Munshi notes that new techniques to define minimal residual disease may identify patients not requiring maintenance.

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

Attal M et al. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N Engl J Med 2012;366(19):1782-91. Abstract

Attal M et al. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma: Follow-up analysis of the IFM 2005-02 trial. Proc ASH 2013;Abstract 406.

McCarthy P et al. The emerging role of consolidation and maintenance therapy for transplant-eligible multiple myeloma patients. Expert Rev Hematol 2014;7(1):55-66. Abstract