Maintenance therapy for multiple myeloma (MM) occurs after successful treatment. At this stage, doctors may use immunomodulatory drugs and proteasome inhibitors to stop MM from coming back.
MM is a bone marrow cancer. It can affect bones throughout the body. It usually appears in older adults, with the median age at diagnosis being
This article looks at maintenance therapy, a type of treatment doctors can use for MM.
It will detail the goals of maintenance therapy and the main types. It also looks at how long maintenance therapy lasts and its impact on a person’s quality of life.
Doctors
Maintenance therapy aims to make this period last as long as possible, and it
To reach remission, however, a person will first need other forms of treatment.
They may include:
As long as maintenance therapy is effective, individuals with MM will not need these treatments again. However, if maintenance therapy stops working, they may need further treatment using these options.
Maintenance therapy can take various forms, but it always involves pharmaceuticals.
Scientists are not always sure exactly how these drugs work, but studies show that they can help people stay in remission.
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Immunomodulatory drugs
Immunomodulatory drugs work by temporarily changing how a person’s immune system works.
There is
A person will take one oral dose per day. Doctors prefer to prescribe lenalidomide because it has shown good results. Moreover, thalidomide has several known and serious adverse effects.
Proteasome inhibitors
Proteasome inhibitors prevent certain enzyme complexes from breaking down specific proteins. These complexes are the proteasomes, and the proteins function to control cell division.
Scientists have investigated whether the following proteasome inhibitors can help maintain MM remission:
As stand-alone maintenance therapies, there is limited
Ixazomib is an oral medication, but doctors
Combination therapy
Certain medications appear to maintain MM remission for some time. However, current options remain limited, as
For this reason, scientists have begun testing whether a combined approach might work better.
In particular, tests have looked at whether lenalidomide may work better in combination with various other medications including proteasome inhibitors.
These combined approaches include:
- lenalidomide and bortezomib
- lenalidomide and ixazomib
- lenalidomide and carfilzomib
- lenalidomide and vorinostat
- lenalidomide and anti-CD38 monoclonal antibody therapy
- lenalidomide and elotuzumab (Empliciti)
Some evidence suggests that lenalidomide and anti-CD38 monoclonal antibody therapy may be the most promising option.
However, scientists are unsure how effective combination therapy can be or how the side effects of combining the drugs will affect a person.
Maintenance therapy is a long-term treatment option. Scientists have studied the safety and effectiveness of MM maintenance therapy for periods lasting
Doctors can prescribe this treatment on an ongoing basis. Treatment may stop only if MM relapses or the adverse effects are too harmful to the individual.
Doctors are also free to reduce dosages and change therapy schedules. In this way, a person could continue to receive MM maintenance therapy for several years.
Maintenance therapy for MM can have adverse effects. Individuals may experience these differently, but a
However, some MM maintenance therapies are less likely to cause side effects.
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MM is a relatively rare bone marrow cancer. If initial treatment options lead to remission, a doctor may recommend maintenance therapy to keep MM at bay for as long as possible.
The main MM maintenance therapy drug is lenalidomide, an immunomodulatory drug.
When it works, maintenance therapy allows people with MM to live without symptoms for some time. With the options currently available, however, MM usually comes back eventually.
In the future, scientists may find that combining various drugs with lenalidomide will provide longer remission.