Maintenance therapy for multiple myeloma (MM) occurs after successful treatment. At this stage, doctors may use immunomodulatory drugs and proteasome inhibitors to stop MM from coming back.

MM is a bone marrow cancer. It can affect bones throughout the body. It usually appears in older adults, with the median age at diagnosis being 70 years. It is relatively uncommon.

This article looks at maintenance therapy, a type of treatment doctors can use for MM.

It will detail the goals of maintenance therapy and the main types. It also looks at how long maintenance therapy lasts and its impact on a person’s quality of life.

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Doctors prescribe maintenance therapy to prolong MM remission. MM remission is when the symptoms lessen or disappear completely.

Maintenance therapy aims to make this period last as long as possible, and it may improve survival rates for people with MM.

To reach remission, however, a person will first need other forms of treatment.

They may include:

As long as maintenance therapy is effective, individuals with MM will not need these treatments again. However, if maintenance therapy stops working, they may need further treatment using these options.

What are stem cell transplants for MM?

Maintenance therapy can take various forms, but it always involves pharmaceuticals.

Scientists are not always sure exactly how these drugs work, but studies show that they can help people stay in remission.

A 2021 review discusses the main ways doctors use maintenance therapy for MM.

Immunomodulatory drugs

Immunomodulatory drugs work by temporarily changing how a person’s immune system works.

There is solid evidence that the following drugs can help maintain remission of MM:

A person will take one oral dose per day. Doctors prefer to prescribe lenalidomide because it has shown good results. Moreover, thalidomide has several known and serious adverse effects.

Proteasome inhibitors

Proteasome inhibitors prevent certain enzyme complexes from breaking down specific proteins. These complexes are the proteasomes, and the proteins function to control cell division.

Scientists have investigated whether the following proteasome inhibitors can help maintain MM remission:

As stand-alone maintenance therapies, there is limited evidence to confirm that proteasome inhibitors work. As a result, there is no standardized treatment regimen for these drugs in the context of MM maintenance therapy.

Ixazomib is an oral medication, but doctors usually deliver bortezomib and carfilzomib intravenously. Sometimes, they administer bortezomib as a subcutaneous injection, which is an injection under the skin.

Combination therapy

Certain medications appear to maintain MM remission for some time. However, current options remain limited, as most people who receive them eventually experience a relapse.

For this reason, scientists have begun testing whether a combined approach might work better.

In particular, tests have looked at whether lenalidomide may work better in combination with various other medications including proteasome inhibitors.

These combined approaches include:

  • lenalidomide and bortezomib
  • lenalidomide and ixazomib
  • lenalidomide and carfilzomib
  • lenalidomide and vorinostat
  • lenalidomide and anti-CD38 monoclonal antibody therapy
  • lenalidomide and elotuzumab (Empliciti)

Some evidence suggests that lenalidomide and anti-CD38 monoclonal antibody therapy may be the most promising option.

However, scientists are unsure how effective combination therapy can be or how the side effects of combining the drugs will affect a person.

How do doctors check if MM is progressing?

Maintenance therapy is a long-term treatment option. Scientists have studied the safety and effectiveness of MM maintenance therapy for periods lasting 1–3 years.

Doctors can prescribe this treatment on an ongoing basis. Treatment may stop only if MM relapses or the adverse effects are too harmful to the individual.

Doctors are also free to reduce dosages and change therapy schedules. In this way, a person could continue to receive MM maintenance therapy for several years.

What are the stages of MM?

Maintenance therapy for MM can have adverse effects. Individuals may experience these differently, but a 2018 study notes that possible side effects include:

However, some MM maintenance therapies are less likely to cause side effects.

A 2020 study notes that shorter-term lenalidomide-based therapy and other longer-term therapies may be less likely to affect a person’s quality of life.

Can diet help manage MM?

MM is a relatively rare bone marrow cancer. If initial treatment options lead to remission, a doctor may recommend maintenance therapy to keep MM at bay for as long as possible.

The main MM maintenance therapy drug is lenalidomide, an immunomodulatory drug. Research suggests it is effective in maintaining MM remission, although scientists are looking for more effective ways to use this and other drugs.

When it works, maintenance therapy allows people with MM to live without symptoms for some time. With the options currently available, however, MM usually comes back eventually.

In the future, scientists may find that combining various drugs with lenalidomide will provide longer remission.