Fixed duration vs continuous therapy in multiple myeloma

Hematology
Heinz Ludwig, Niklas Zojer

Abstract

The introduction of new drugs with less severe toxicity profiles than those of conventional antimyeloma agents allowed the evaluation of continuous therapy compared with fixed duration therapy. In transplant-eligible patients, consolidation therapy with bortezomib or bortezomib-based regimens showed significant progression-free survival (PFS) benefit in cytogenetic standard-risk patients and to a lesser extent, high-risk patients. Continuous therapy with lenalidomide maintenance treatment after autologous stem cell transplantation resulted in a significant survival gain. In transplant noneligible patients, continuous lenalidomide-dexamethasone therapy improved survival over fixed duration melphalan-prednisone-thalidomide. The concept of prolonged treatment in elderly patients is supported by some other studies, but most of them revealed a gain in PFS only. Young patients with unfavorable prognosis show a greater willingness to accept long-term treatment, whereas the readiness to undergo such treatments and the benefits therefrom decline with increasing age and decreasing fitness, rendering fixed duration therapy a suitable option in elderly frail patients.

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Citations

Apr 2, 2019·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Joseph MikhaelTom Martin
Aug 18, 2018·Clinical Pharmacokinetics·Neeraj GuptaKarthik Venkatakrishnan
Nov 9, 2018·Pathology Oncology Research : POR·Ildikó PálLászló Váróczy
Oct 7, 2020·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Meletios A DimopoulosUNKNOWN TOURMALINE-MM4 study group
Mar 2, 2021·Biochemical and Biophysical Research Communications·Qingqing WangXuyan Chen
Aug 4, 2021·Future Oncology·José-Ángel Hernández-RivasErnesto Pérez Persona

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