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Blood Cancers Video Library: Multiple Myeloma – What is the Role of Maintenance Therapy, What do you do After?

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GRACE joined a number of top faculty in the area of hematology in Whistler BC, for the 3rd Annual Summit on Hematologic Malignancies.  Amrita Krishnan, MD, F.A.C.P., Director Judy and Bernard Briskin Center for Multiple Myeloma Research, Director of the Multiple Myeloma Program and Associate Director of the Medical Education and Training Program at the City of Hope, Duarte, California, spoke with GRACE about Multiple Myeloma, what is the role of maintenance therapy, is there a best maintenance therapy, and what you do after maintenance therapy.

 

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Multiple Myeloma – What is the role of maintenance therapy, is there a best maintenance therapy, and what do you do after?

Amrita Krishnan, MD, F.A.C.P.

Director Judy and Bernanrd Briskin Center for Multiple Myeloma Research, Director Multiple Myeloma Program

Associate Director of Medical Education and Training Program, City of Hope, Duarte, California

 

The other question is really: What do you do after transplant or even after just regular therapy? What we’re also learning in our treatment of myeloma is that duration of therapy is important, especially this concept of maintenance therapy. We think that patients often have very low levels of myeloma in their body even after transplant, after all these other drugs we give, and the way to help prevent the myeloma from clinically relapsing or becoming apparent is by putting patients on maintenance which is a concept of giving very low doses of treatment continuously. What we struggle to find is obviously a balance, so we’re looking for balancing toxicity, quality of life with maintenance versus efficacy, or how well does it work. We want something that works, but ideally something that’s convenient for patients, something that has the least amount of side effects.

Right now the two drugs that we have for maintenance, usually in the U.S. at least, are lenalidomide and bortezomib. Again, that may also change now that we have these other drugs approved such as the oral inhibitor proteasome ixazomib. Certainly we’re very interested in the setting of clinical trials to see if that would be a good option for maintenance.

The other challenge for us is we still don’t really agree as a community of myeloma doctors how long should you be on maintenance. Often patients will go to one doctor versus another and they’ll get two different opinions. That doesn’t mean they’re wrong opinions it just means it’s different approaches to treatment of the disease. That can be confusing to patients. I also think of it as meaning that there’s a lot of great options for patients so the fact that you don’t get one answer means that it’s really finding the answer that works best for you.

 

 

 

 

 


 

 

 


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