[goldmine848]

Post-transplant maintenance choices

by goldmine848 on Fri Feb 28, 2014 6:49 pm

I did my transplant and I am now considering maintenance regimes. I know that there are studies confirming the efficacy of Revlimid maintenance over no maintenance. Is anyone aware of studies comparing Revlimid maintenance to Velcade, Revlimid, and Dex maintenance? I ask because my doctor said that VRD maintenance is the most aggressive approach while conceding that using VRD for this purpose is controversial.

[Dr. Ken Shain]

Re: Post-transplant maintenance choices

by Dr. Ken Shain on Sat Mar 01, 2014 8:36 am

There are have been no published results of studies comparing the the different agents head to head. For the most part, the decisions about whether or not to start maintenance therapy and what drugs to use are based on a number of competing factors. And it is impossible and inappropriate to compare results across clinical trials.

Unfortunately, today we do not yet know what maintenance is a perfect fit or would be the best for each patient. Induction therapy (or second), residual side effects, tolerance, disease status post transplant, risk stratification, social considerations, patient preferences, and even financial issues can all contribute to the decision.

However, there is excellent data (although somewhat controversial) regarding maintenance therapy and the rationale for it. Know that all therapies have are risks as well as benefits that need to be discussed/reviewed. Further, quality of life should be a critical aspect to consider while on maintenance.

Continue to discuss with your oncologist and/or feel free to seek a second opinion.

[Wayne K]

Re: Post-transplant maintenance choices

by Wayne K on Sat Mar 01, 2014 8:10 pm

I know that maintenance regimens are popular, but I had none after my SCT. I'm coming out of a CR, but my SCT was in April of '10.

I'm no doctor, but I do wonder if multiple myeloma can develop a resistance. Isn't there a possibility that it would be reinforced with maintenance?

[DallasGG]

Re: Post-transplant maintenance choices

by DallasGG on Tue Apr 01, 2014 11:53 am

I am about 53 days post transplant and yesterday I met with my transplant doctor who is also a multiple myeloma specialist and I asked him about what maintenance treatment, if any, I might be going on eventually. He told me that, since I was in complete remission before my transplant and am still in remission after the transplant, he might recommend that I don't have any maintenance treatment. And when I relapse, I could then start a maintenance treatment at that time.

He did tell me about other maintenance options (Revlimid or Velcade, etc.) which I could start after I recover fully from the transplant. He also told me that some of the treatments like Revlimid have potential side effects like causing other cancers. So why take it until you actually have to? And I experienced periperal neuropathy with the Velcade, so that doesn't look like the ideal treatment for me.

Theoretically, if I wait until I relapse, any treatment I take should still work because I haven't become immune to it yet. If someone is in complete remission after a transplant, does it really matter if they go on a maintenance treatment right away or wait until they relapse? Does anyone know of any studies that show a better (or similar outcome) between those approaches?

If the outcome is the same, it makes sense to me to wait to do the maintenance until I relapse.