Consolidation and maintenance therapy of multiple myeloma

Consolidation and maintenance therapies are important concepts in the treatment strategy for patients with multiple myeloma. Consolidation is aimed at deepening the response, ideally to the level of molecular remission. The goal of maintenance therapy is the prevention or delay of disease progression by means of therapy with no or only minimal associated toxicity. The aim of this article is to discuss the results of seminal studies investigating the role of consolidation and maintenance therapy. Original publications and publications in abstract form are discussed. Several trials showed a significant prolongation of progression-free survival (PFS) with immunomodulatory drugs (e.g. thalidomide and lenalidomide) and a number of these investigations indicated an increase in overall survival as well. Bortezomib-based consolidation therapy results in deepening of the response, in particular increase in minimal residual disease negativity and in an improvement of PFS. Presently available data with bortezomib or bortezomib-based maintenance treatment showed remarkable tolerance of prolonged treatment and there are indications of a positive effect on survival outcome parameters. Older concepts, such as interferon alpha maintenance therapy have generally been abandoned.