Autologous hematopoietic stem cell transplantation and maintenance therapy for multiple myeloma

SUMMARY Multiple myeloma is highly treatable with novel agents such as proteasome inhibitors (bortezomib) and the immunomodulatory drugs thalidomide and lenalidomide. However, it remains an incurable disease. Induction regimens incorporating novel agents, as well as autologous hematopoietic stem cell transplantation (AHSCT), have deepened response. Following AHSCT, consolidation and maintenance therapy strategies have been developed to improve response, delay progression and improve overall survival (OS). Maintenance therapy should be effective with minimal toxicity and easily administered. The bisphosphonate zoledronate, thalidomide, lenalidomide and bortezomib improve time to progression and OS when used for maintenance therapy after AHSCT, although it is uncertain whether this improvement in OS can be attributed to the maintenance phase in the case of zoledronate. It is also important to note that few data are available regarding the exact role of bortezomib in the maintenance phase. New therapies alon...