Maintenance or consolidation treatment

As described earlier, the course of myeloma is defined by a pattern of remission and relapse so salvage treatment is needed when patients relapse. However, remission periods often become increasingly shorter with subsequent treatments because of acquired drug resistance. Ultimately most patients become refractory to treatment.

Studies have shown that high response rates, especially in the transplant setting, are associated with improved long-term outcomes. Once a patient is in remission, maintaining that state of remission becomes the immediate goal.

Continuing treatment in the form of maintenance (long-term), consolidation (short-term), or consolidation followed by maintenance, has been investigated as a possible way of prolonging response to first-line treatment, especially for those who do not achieve a complete response. Any maintenance therapy must be well tolerated and have an easy route of administration to ensure effective long-term use.

Definitions

• Maintenance treatment is treatment administered long-term and intended to sustain control of the myeloma and reduce the risk of disease progression
• Consolidation treatment is treatment administered over a short period of time with the aim of maximising the depth of response obtained with the previous treatment