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Moving Beyond Autologous Transplantation in Multiple Myeloma: Consolidation, Maintenance, Allogeneic Transplant, and Immune Therapy. Am Soc Clin Oncol Educ Book 2016;35:210-21 PMID: 27249701

Pubmed ID

27249701

DOI

10.14694/EDBK_159016

Abstract

For multiple myeloma, introduction of novel agents as part of the front-line treatment followed by high-dose chemotherapy and autologous hematopoietic stem cell transplantation (ASCT) induces deep responses in a majority of patients with this disease. However, disease relapse is inevitable, and, with each relapse, the remission duration becomes shorter, ultimately leading to a refractory disease. Consolidation and maintenance strategy after ASCT is one route to provide sustained disease control and prevent repeated relapses. Though the consolidation strategy remains largely confined to clinical trials, significant data support the efficacy of consolidation in improving the depth of response and outcomes. There are also increasing rates of minimal residual disease-negativity with additional consolidation therapy. On the other hand, maintenance with novel agents post-transplant is well established and has been shown to improve both progression-free and overall survival. Evolving paradigms in maintenance include the use of newer proteasome inhibitors, immunotherapy maintenance, and patient-specific maintenance-a concept that utilizes minimal residual disease as the primary driver of decisions regarding starting or continuing maintenance therapy. The other approach to overcome residual disease is immune therapeutic strategies. The demonstration of myeloma-specific alloimmunity from allogeneic transplantation is well established. More sophisticated and promising immune approaches include adoptive cellular therapies, tumor vaccines, and immune checkpoint manipulations. In the future, personalized minimal residual disease-driven treatment strategies following ASCT will help overcome the residual disease, restore multiple myeloma-specific immunity, and achieve sustained disease control while minimizing the risk of overtreatment.

Author List

Krishnan A, Vij R, Keller J, Dhakal B, Hari P

Authors

Binod Dhakal MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Parameswaran Hari MD Chief, Professor in the Medicine department at Medical College of Wisconsin




Scopus

2-s2.0-84994889855   3 Citations

MESH terms used to index this publication - Major topics in bold

Antineoplastic Combined Chemotherapy Protocols
Combined Modality Therapy
Disease-Free Survival
Hematopoietic Stem Cell Transplantation
Humans
Immunotherapy
Maintenance Chemotherapy
Multiple Myeloma
Neoplasm Recurrence, Local
Proteasome Inhibitors
Thalidomide
Transplantation, Autologous
jenkins-FCD Prod-331 a335b1a6d1e9c32173c9534e6f6ff51494143916