Role of Maintenance Therapy in the Management of Haematological Malignancies

Abstract

For many years, there have been efforts to identify effective maintenance therapies to prolong response to initial treatment in MM. Although interferon prolonged responses by several months, its toxic adverse effect profile precluded broad clinical use (D.Cunningham et al, 1998), (B. Barlogie et al, 2006). Corticosteroids were also explored in early trials, but efficacy was unconfirmed & in other studies showed modest efficacy in improving PFS (J. R. Berenson et al, 2002). In the era of novel therapies, low-dose thalidomide has been evaluated in both patients ineligible for transplant and those undergoing transplant. In ASCT eligible patients, benefit was observed, as in the largest 5 studies, thalidomide improved progression-free survival, and in three of the five studies, there was improved overall survival (Attal M et al, 2006), (Spencer A et al, 2009), (Morgan GJ et al, 2012). Using thalidomide as maintenance in non intensively treated patients or elderly patients, results indicated that thalidomide had only a marginal effect in improving PFS. Furthermore, it suggests that it may be related to thalidomide exposure at some point during the treatment course rather than directly attributable to its use in maintenance (Morgan GJ et al, 2012).