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Induction vs consolidation vs maintenance?
What is the definition of induction, consolidation, and maintenance therapy?
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gardengirl - Name: gardengirl
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Nov. 2013
- Age at diagnosis: 47
Re: Induction vs consolidation vs maintenance?
I don't have the definition. But I am currently on my consolidation round at UAMS . My induction was the chemo prior to my stem cell collection . I lost my hair after induction. I then got a break and came back for stronger chemo with my tandem stem cell transplants. They were about 6 weeks apart. Now I'm currently doing my consolidation round. It is the same chemo agents that were used during the induction but has been reduced by 25%.
I might have another consolidation round in January as well.
I wear the bag for 4 days and then wait for my counts to bottom. They give me Neupogen once a day during consolidation . I had it twice a day during the induction to prepare for the stem cell collection.
The maintenance will probably consist of VRD [Velcade, Revlimid, dexamethasone].
I don't think many places do the consolidation round . I think of it as chemo period on the stem cells that were put back. A clean sweep.
I might have another consolidation round in January as well.
I wear the bag for 4 days and then wait for my counts to bottom. They give me Neupogen once a day during consolidation . I had it twice a day during the induction to prepare for the stem cell collection.
The maintenance will probably consist of VRD [Velcade, Revlimid, dexamethasone].
I don't think many places do the consolidation round . I think of it as chemo period on the stem cells that were put back. A clean sweep.
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angcomfort - Name: Angela Comfort
- Who do you know with myeloma?: no one
- When were you/they diagnosed?: 01/12/14
- Age at diagnosis: 39
Re: Induction vs consolidation vs maintenance?
Induction is the therapy stage that precedes stem cell collection and the high-dose chemo/transplant stage. The intent is to safely reduce the cancer cell burden as much as possible prior to stem cell collection. Induction is usually based on a cocktail of drugs.
Consolidation is an optional phase that reinforces the gains made from the transplant phase, especially if the disease was not wiped out completely by the high-dose chemo and transplant stages, or if you are undergoing a no-holds barred treatment approach like Total Therapy from UAMS. The induction and consolidation drugs could be one in the same or they can differ from one another, and their dose levels can differ (as Angela points out in her case)
Maintenance is a longer term therapy stage to help keep the disease in check over period of a years. Maintenance is usually based on just one drug such as Velcade or Revlimid, but this is not always the case (again, as Angela points out, in the case of Total Therapy, UAMS is using VRD).
All of these stages and their duration can get blurred and they can bleed into one another (i.e. the consolidation and maintenance stages might be one in the same and a patient could use the same drug combo for both stages over a period of years). Or if you aren't doing a transplant, induction and consolidation could essentially be one in the same. The drugs used can also vary from stage to stage or they could end up being one in the same. It all depends on the patient' s circumstances and the doctor that you are working with.
Consolidation is an optional phase that reinforces the gains made from the transplant phase, especially if the disease was not wiped out completely by the high-dose chemo and transplant stages, or if you are undergoing a no-holds barred treatment approach like Total Therapy from UAMS. The induction and consolidation drugs could be one in the same or they can differ from one another, and their dose levels can differ (as Angela points out in her case)
Maintenance is a longer term therapy stage to help keep the disease in check over period of a years. Maintenance is usually based on just one drug such as Velcade or Revlimid, but this is not always the case (again, as Angela points out, in the case of Total Therapy, UAMS is using VRD).
All of these stages and their duration can get blurred and they can bleed into one another (i.e. the consolidation and maintenance stages might be one in the same and a patient could use the same drug combo for both stages over a period of years). Or if you aren't doing a transplant, induction and consolidation could essentially be one in the same. The drugs used can also vary from stage to stage or they could end up being one in the same. It all depends on the patient' s circumstances and the doctor that you are working with.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Induction vs consolidation vs maintenance?
Multibilly's definitions are basically correct, I believe. The one thing I would say is not quite correct is the tying of the definitions to transplantation.
Induction therapy, consolidation therapy, and maintenance therapy are all general terms from the world of cancer treatment. In the myeloma world, they often get connected to the concept of transplantation because SCTs are so common, but they really have meanings separate from that concept.
Induction therapy is just the first therapy given to a cancer patient, whether or not it's followed by stem cell collection or transplantation.
Consolidation therapy is treatment given after initial (induction) therapy to "mop up" whatever cancer the initial therapy was not able to accomplish. You will find discussions of transplantation for myeloma, for example, that describe it as consolidation therapy. Consolidation therapy is generally more intensive therapy than maintenance therapy and intended to be given for a relatively short period of time -- months rather than years.
Maintenance therapy is treatment given after induction therapy (and, if it's done, after consolidation therapy) that is generally less intensive than either induction therapy or consolidation therapy. Its goal is more to prevent the cancer from coming back, although in myeloma it sometimes also is used for consolidative purposes (i.e., to deepen responses). In addition, it is intended to be given for extended periods of time -- years, and perhaps even indefinitely, rather than months.
Here are the National Cancer Institute's definitions of induction, consolidation, and maintenance therapy:
Induction therapy - "The first treatment given for a disease. It is often part of a standard set of treatments, such as surgery followed by chemotherapy and radiation. When used by itself, induction therapy is the one accepted as the best treatment. If it doesn’t cure the disease or it causes severe side effects, other treatment may be added or used instead. Also called first-line therapy, primary therapy, and primary treatment."
http://www.cancer.gov/dictionary?CdrID=45736
Consolidation therapy - "Treatment that is given after cancer has disappeared following the initial therapy. Consolidation therapy is used to kill any cancer cells that may be left in the body. It may include radiation therapy, a stem cell transplant, or treatment with drugs that kill cancer cells. Also called intensification therapy and postremission therapy."
http://www.cancer.gov/dictionary?CdrID=45654
Maintenance therapy - "Treatment that is given to help keep cancer from coming back after it has disappeared following the initial therapy. It may include treatment with drugs, vaccines, or antibodies that kill cancer cells, and it may be given for a long time."
http://www.cancer.gov/dictionary?CdrID=45768
Induction therapy, consolidation therapy, and maintenance therapy are all general terms from the world of cancer treatment. In the myeloma world, they often get connected to the concept of transplantation because SCTs are so common, but they really have meanings separate from that concept.
Induction therapy is just the first therapy given to a cancer patient, whether or not it's followed by stem cell collection or transplantation.
Consolidation therapy is treatment given after initial (induction) therapy to "mop up" whatever cancer the initial therapy was not able to accomplish. You will find discussions of transplantation for myeloma, for example, that describe it as consolidation therapy. Consolidation therapy is generally more intensive therapy than maintenance therapy and intended to be given for a relatively short period of time -- months rather than years.
Maintenance therapy is treatment given after induction therapy (and, if it's done, after consolidation therapy) that is generally less intensive than either induction therapy or consolidation therapy. Its goal is more to prevent the cancer from coming back, although in myeloma it sometimes also is used for consolidative purposes (i.e., to deepen responses). In addition, it is intended to be given for extended periods of time -- years, and perhaps even indefinitely, rather than months.
Here are the National Cancer Institute's definitions of induction, consolidation, and maintenance therapy:
Induction therapy - "The first treatment given for a disease. It is often part of a standard set of treatments, such as surgery followed by chemotherapy and radiation. When used by itself, induction therapy is the one accepted as the best treatment. If it doesn’t cure the disease or it causes severe side effects, other treatment may be added or used instead. Also called first-line therapy, primary therapy, and primary treatment."
http://www.cancer.gov/dictionary?CdrID=45736
Consolidation therapy - "Treatment that is given after cancer has disappeared following the initial therapy. Consolidation therapy is used to kill any cancer cells that may be left in the body. It may include radiation therapy, a stem cell transplant, or treatment with drugs that kill cancer cells. Also called intensification therapy and postremission therapy."
http://www.cancer.gov/dictionary?CdrID=45654
Maintenance therapy - "Treatment that is given to help keep cancer from coming back after it has disappeared following the initial therapy. It may include treatment with drugs, vaccines, or antibodies that kill cancer cells, and it may be given for a long time."
http://www.cancer.gov/dictionary?CdrID=45768
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JimNY
Re: Induction vs consolidation vs maintenance?
Jim:
I agree with what you are saying and I think we are basically saying the same thing, just a bit differently.
I agree with what you are saying and I think we are basically saying the same thing, just a bit differently.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Induction vs consolidation vs maintenance?
Oh, I agree Multibilly. Sorry if what I wrote at the beginning of my post came across as suggesting we were miles apart in our definitions. We're not.
I really just wanted to make it clear that the terms have definitions that are independent of whether or not a myeloma patient undergoes a stem cell transplant.
I really just wanted to make it clear that the terms have definitions that are independent of whether or not a myeloma patient undergoes a stem cell transplant.
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JimNY
Re: Induction vs consolidation vs maintenance?
Jim, I didn't take your comment that way at all. Thanks for clarifying the point.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Induction vs consolidation vs maintenance?
I am new to the world of multiple myeloma. And I am wondering, after induction therapy, how many different therapies options are there? I imagine there are only so many things that you can try (even though some may work for years) before you eventually run out of options.
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heatherlib - Name: heather
- Who do you know with myeloma?: self
- When were you/they diagnosed?: may 2014
- Age at diagnosis: 52
Re: Induction vs consolidation vs maintenance?
Hi Heather,
How many treatment options there are for a myeloma patient is a really complicated question. The easy answer is "not enough" because, eventually, almost all of us diagnosed as young as you will run out of good treatment options eventually . There are a lot of drugs approved, though - the list below is from the National Cancer Institute (NCI), and some combination regimens use even more drugs than this (VDT-PACE includes cisplatin and etoposide for example, which the NCI doesn't even list.)
Bendamustine (Treanda) - chemotherapy
Carmustine - chemotherapy
Melphalan (Alkeran) - chemotherapy (often used as a high dose supported by stem cell transplant)
Cyclophosphamide (Cytoxan) - chemotherapy
Doxorubicin hydrochloride liposome (Doxil) - chemotherapy
Prednisone - steroid
Dexamethasone (Decadron) - steroid
Thalidomide (Thalomid) - 1st generation immunomodulatory agent
Lenalidomide (Revlimid) - 2nd generation immunomodulatory agent
pomalidomide (Pomalyst, Imnovid) - 3rd generation immunomodulatory agent
Bortezomib (Velcade) - proteasome inhibitor
Carfilzomib (Kyprolis) - proteasome inhibitor
Although this is a pretty long list, not all these drugs are available in every country. Some are not appropriate for all patients, and few of them work very well by themselves. In most cases, combinations of drugs work better for myeloma than single agents. You can see also that a lot of the drugs are in the same categories. New categories of drugs are being tested now in clinical trials and more options may be available soon.
How many treatment options there are for a myeloma patient is a really complicated question. The easy answer is "not enough" because, eventually, almost all of us diagnosed as young as you will run out of good treatment options eventually . There are a lot of drugs approved, though - the list below is from the National Cancer Institute (NCI), and some combination regimens use even more drugs than this (VDT-PACE includes cisplatin and etoposide for example, which the NCI doesn't even list.)
Bendamustine (Treanda) - chemotherapy
Carmustine - chemotherapy
Melphalan (Alkeran) - chemotherapy (often used as a high dose supported by stem cell transplant)
Cyclophosphamide (Cytoxan) - chemotherapy
Doxorubicin hydrochloride liposome (Doxil) - chemotherapy
Prednisone - steroid
Dexamethasone (Decadron) - steroid
Thalidomide (Thalomid) - 1st generation immunomodulatory agent
Lenalidomide (Revlimid) - 2nd generation immunomodulatory agent
pomalidomide (Pomalyst, Imnovid) - 3rd generation immunomodulatory agent
Bortezomib (Velcade) - proteasome inhibitor
Carfilzomib (Kyprolis) - proteasome inhibitor
Although this is a pretty long list, not all these drugs are available in every country. Some are not appropriate for all patients, and few of them work very well by themselves. In most cases, combinations of drugs work better for myeloma than single agents. You can see also that a lot of the drugs are in the same categories. New categories of drugs are being tested now in clinical trials and more options may be available soon.
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Tough Mom - Who do you know with myeloma?: myself
- When were you/they diagnosed?: January 2013
- Age at diagnosis: 45
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