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Lenalidomide maintenance in myeloma

Nature Reviews Clinical Oncology volume 9, page 605 (2012)Cite this article

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We strongly agree with Rajkumar (Haematological cancer: Lenalidomide maintenance—perils of a premature denouement. Nat. Rev. Clin. Oncol. 9, 372–374; 2012)1 that it is premature to recommend lenalidomide maintenance to all patients with myeloma, but we would also like to underline other aspects of the problem not discussed in the recent commentary article.

It is our assertion that not every patient with myeloma needs maintenance therapy. In addition to considering the risk–benefit ratio for a patient during maintenance therapy, we are convinced that the well-known concept of disease plateau—which was established decades before the novel-agent era in myeloma2—is also applicable in the setting of maintenance therapy. Furthermore, a small percentage of patients (15%, but this could improve with novel agents used in the pre-transplant setting) after autologous stem-cell transplantation (ASCT) achieve disease-free survival or progression-free survival of longer than 10 years.3 For those patients, any maintenance therapy is useless or, even worse, harmful. When considering maintenance therapy, especially after ASCT, the primary aim should be a survival benefit for the patients. Other considerations should include patient quality of life and cost effectiveness.

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Acknowledgements

The authors would like to thank Siena A. I. L. (Italian Association against Leukemia, Lymphoma and Myeloma, Siena District, Italy), and all the doctors, nurses, and laboratory technicians working at the Division of Hematology and Transplants, AOUS, Policlinico Le Scotte, Siena for their daily assistance in patient care.

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  1. Division of Hematology and Transplants, University of Siena, Policlinico “Santa Maria alle Scotte”, Viale Bracci 16, Siena, 53100, Italy

    Alessandro Gozzetti, Marzia Defina & Monica Bocchia

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  1. Alessandro Gozzetti
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  2. Marzia Defina
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  3. Monica Bocchia
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Correspondence to Alessandro Gozzetti.

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The authors declare no competing financial interests.

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Gozzetti, A., Defina, M. & Bocchia, M. Lenalidomide maintenance in myeloma. Nat Rev Clin Oncol 9, 605 (2012). https://doi.org/10.1038/nrclinonc.2012.100-c1

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