The risks of stopping multiple myeloma maintenance therapy include quicker disease progression and a shorter survival time. People may stop due to medication side effects, such as tiredness.
Many people with multiple myeloma undergo a stem cell transplant to treat the disease. After the transplant, they begin maintenance therapy to treat the cancer. However, some people may stop maintenance therapy.
This article discusses the risks and reasons for stopping treatment for multiple myeloma. It also examines current and new therapies for people whose treatment has stopped working.
Stopping treatment can lead to the following:
Shorter overall survival
Researchers in a
There were 238 participants in the late group. They stopped treatment after 3 years. There were 102 participants in the early group. They stopped treatment before 3 years.
Researchers found the 5-year overall survival rate of the group who stopped maintenance therapy after 3 years was 96%.
The overall survival rate for the group who stopped maintenance therapy before 3 years was 79%.
Shorter progression-free survival
Researchers found the 5-year progression-free survival rate was 80% in the late group and 50% in the early group.
Increased risk of complications
The risk of complications increases with no treatment to prevent or slow progression.
- hypercalcemia, which is higher blood calcium levels
- skeletal disease, which can manifest in bone pain and fractures
- kidney insufficiency, a condition that involves some degree of kidney failure
- anemia, a deficiency of red blood cells or hemoglobin, which is a protein in red blood cells that carries oxygen
- neuropathy, which is dysfunction in one or more nerves
Reasons people may stop maintenance therapy after a stem cell transplant include:
In the 2022 study discussed above,
The most common side effects unrelated to blood counts were diarrhea and tiredness.
Desire to try alternative treatments
Some people may prefer to try alternative medicine treatments.
Alternative medicine encompasses interventions such as:
- vitamins and herbs
- certain diets
While some of these treatments may help reduce symptoms, research
Additionally, some alternative medicine treatments may be unsafe.
Treatment stops working
Some people may stop a specific treatment course for multiple myeloma if they feel it no longer benefits them or for other reasons. In this case, a doctor can best advise on the next steps.
When treatment for multiple myeloma stops working, doctors recommend changes in a person’s treatment regimen to prolong survival.
- a change in treatment if it stops working before 6 months
- use of previous treatment if treatment stops working after 6 months
- autologous, or self-derived, stem cell transplantation if treatment stops working after 18 months in people not taking maintenance therapy
- autologous stem cell transplantation if treatment stops working after 36 months in people taking maintenance therapy or enrolled in a clinical trial
The current and newer treatments available for RRMM include:
For these cases of multiple myeloma, treatment options include:
- Immunomodulatory agents (IMiDs): This class of drugs
modifiesthe immune response, reduces the blood supply to cancer, and has direct anticancer activity. An example is lenalidomide (Revlimid).
- Proteasome inhibitors: These drugs help promote the death of multiple myeloma cells. An example is carfilzomib (Kyprolis).
- Monoclonal antibodies: These drugs
attackspecific targets on cancer cells and boost the body’s immune response to cancer. An example is elotuzumab (Empliciti).
- Alkylating agents: These drugs act on DNA in a way that
helps preventcancer cells from multiplying. An example is cyclophosphamide (Cytoxan).
Enrolling in a clinical trial is a way to access the latest treatments.
Clinical trials are carefully controlled studies that investigate the safety and effectiveness of new drugs or treatments.
However, clinical trials are
- Chimeric antigen receptor T-cell (CAR T-cell) therapy: These drugs target a substance called anti-B cell maturation antigen, which is
elevatedin people with multiple myeloma. The FDA has approved two products in this category, one of which is ciltacabtagene autoleucel (cilta-cel).
- Bispecific T-cell engagers (BITEs): These drugs lead to myeloma cell decomposition. The FDA has approved some options for people who previously received at least four therapy lines. One option is teclistamab (Tecvayli).
- Cereblon E3 ligase modulators (CELMoDs): These drugs help degrade a substance involved in multiple myeloma. Clinical trials are currently studying iberdomide and mezigdomide.
Learn more about treatments for multiple myeloma.
The risks of stopping maintenance therapy after stem cell transplant for multiple myeloma include shorter overall and progression-free survival.
Another risk is the increased likelihood of developing complications, such as anemia and infection.
The most frequent reason for stopping maintenance treatment early is the side effects of medication. When treatment stops working, doctors have various options, such as changing the medication or using a previous medication.
One of the current treatment options for refractory multiple myeloma is a class of drugs called monoclonal antibodies. Newer options include various cellular and immunologic treatments.