Tailoring Maintenance Therapy by Patient Risk: Lenalidomide Alone vs Combination Approaches

EP: 1.Treatment Approaches and Goals: Transplant-Eligible vs. Transplant-Ineligible Patients

EP: 2.The Role of ASCT in Frontline Myeloma: Comparative Risks and Benefits with Other Standard Treatment Approaches

EP: 3.Evaluating First-Line Treatment Options: Quadruplet vs Triplet Regimens and NCCN Guidelines

EP: 4.The Role of MRD Status in Post-ASCT Treatment Decisions and Clinical Integration

Now Viewing

EP: 5.Tailoring Maintenance Therapy by Patient Risk: Lenalidomide Alone vs Combination Approaches

EP: 6.Balancing Timing of ASCT: Insights on Delayed Transplantation and Long-Term Treatment Outcomes

This segment discusses how maintenance therapy should be tailored based on different patient risk profiles and examines current evidence supporting lenalidomide alone vs combination maintenance strategies. For standard-risk patients, single-agent lenalidomide maintenance remains the institutional standard, though emerging data suggests limited-duration maintenance may offer benefits for some patients. The approach requires careful consideration of individual patient factors and ongoing clinical trial results to determine optimal maintenance duration and intensity.

High-risk multiple myeloma patients require more intensive maintenance approaches beyond single-agent lenalidomide. The discussion describes institutional experience with combination maintenance regimens, including lenalidomide plus proteasome inhibitor combinations that have been used since 2012. These triplet-based consolidation and maintenance strategies are considered optimal for high-risk patients, as they provide more durable responses than single-agent approaches, addressing the characteristic pattern of deep but nondurable responses in high-risk disease.

The integration of CD38 antibodies into maintenance regimens represents an evolving area of clinical practice. Questions remain about whether CD38 antibodies should be added to existing doublet regimens or replace components to maintain triplet therapy. The panel emphasizes that high-risk patients achieving MRD negativity at 6 to 9 months should not be considered cured, as these responses typically lack durability. The discussion concludes that while significant progress has been made in maintenance therapy, fine-tuning approaches for different patient populations remains an active area of clinical development.