Post Autologous Stem Cell Transplantation Maintenance for Multiple Myeloma Patients: Real World Experience and Results

Maintenance therapy is routinely prescribed for multiple myeloma (MM) patients after autologous stem cell transplantation (ASCT). In this retrospective analysis, we evaluated 257 post-ASCT MM patients and compared the effect of various maintenance therapies used in our institution. These include cyclophosphamide (Cy), interferon alpha ± steroids (IST), immunomodulatory drugs (IMiDs) and proteasome inhibitors. Comparisons between maintenance groups in the first (post-ASCT) and second line (post-salvage) setting demonstrate no significant differences in progression free survival (PFS) with the exception of IMiDs. These agents, when utilized in the first line maintenance setting, resulted in superior PFS and OS compared to IST (p= 0.0031 and 0.029, respectively) and no maintenance therapy (p= 0.009 and 0.035, respectively). Surprisingly, in the second line maintenance therapy Cy use was associated with a trend favoring improved PFS compared to IMiDs, IFN ± steroids (IST) and bortezomib (Bor) maintenance. Overall survival comparisons demonstrate equivalence between Cy and IST or Bor maintenance groups. Our study confirms advantage of IMiDs as post ASCT maintenance, while the data show that Cy maintenance can be a good alternative in patients who are intolerant or cannot afford IMiDs maintenance, both in first and second line maintenance.