Advances in maintenance strategy in newly diagnosed multiple myeloma patients eligible for autologous transplantation

Ahsan Wahab, Abdul Rafae, Muhammad Salman Faisal, Kamran Mushtaq, Hamid Ehsan, Maria Khakwani, Afia Ashraf, Tayyab Rehan, Zahoor Ahmed, Zunairah Shah, Aslam Khan, Faiz Anwer

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Introduction: Multiple myeloma (MM) lacks curative therapy. Therefore, researchers continue to conduct studies in an effort to improve progression-free survival (PFS) and overall survival (OS). Maintenance therapy (MT) after autologous stem cell transplant (ASCT) was extensively studied in the last decade and now considered a standard approach. Areas covered: This review evaluated the evidence and updates on various maintenance agents in newly diagnosed multiple myeloma (NDMM) after ASCT. Articles were searched on PubMed and Embase that were published in last 10 years. Both clinical trials and observational studies were evaluated. Expert opinion: Maintenance strategy after ASCT has consistent PFS benefit but lacks conclusive OS improvement. Lenalidomide is superior to thalidomide given reduced neurotoxicity. OS advantage is controversial for both due to inconsistent evidence. Lenalidomide may confer a PFS advantage even at lower doses due to toxicity with higher doses. Bortezomib-based maintenance has some evidence for OS benefit in high-risk MM (HRMM) and renal dysfunction. Ixazomib has preliminary promising results. Two or three drug combinations for MT are potentially safe and more effective, particularly in HRMM although data on this subject is still evolving. Efficacy of various MT regimens in terms of minimal residual disease status needs to be further investigated.

Original languageEnglish (US)
Pages (from-to)1333-1347
Number of pages15
JournalExpert Review of Hematology
Issue number12
StatePublished - 2020
Externally publishedYes


  • Maintenance therapy
  • minimal-residual disease
  • multiple myeloma
  • overall survival
  • progression-free survival

ASJC Scopus subject areas

  • Hematology


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