Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
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Revlimid Maintenance- How Long?
How long should myeloma patients undergo Revlimid maintenance therapy? This question has two answers for two different groups of MM patients-
- Those MM patients who are MRD negative, three years if MRD negative status is continuous- see the article below-
- Those MM patients who are MRD positive- continuous maintenance therapy until the patient relapses or until side effects become intolerable-
The standard-of-care therapy plan for all newly diagnosed myeloma patients is:
- Induction therapy-
- Autologous stem cell transplant-
- Low-dose maintenance therapy
How long should myeloma patients take Revlimid maintenance therapy if they are not MRD negative?
🔹 Standard Recommendation (For MRD-positive patients):
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Duration: Continuous Revlimid maintenance (i.e., until progression or intolerance).
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This approach is supported by major trials such as CALGB 100104 and IFM 2005-02, which showed significantly improved progression-free survival (PFS) and overall survival (OS) with continuous Revlimid maintenance compared to placebo or limited-duration therapy, even in MRD-positive patients.
🔹 Rationale for Extended Maintenance in MRD-positive Patients:
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Patients who are MRD-positive remain at higher risk of relapse, so ongoing therapy helps to control residual disease.
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Continuous maintenance may delay progression and extend survival, even if MRD-negative status is not achieved.
🔹 Considerations and Individualization:
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Toxicity: Some patients develop side effects such as cytopenias, secondary malignancies, or fatigue, which may require dose adjustments or discontinuation.
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Age/comorbidities: Older or frail patients may not tolerate long-term therapy as well.
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MRD monitoring: Some centers use MRD status as a biomarker to guide therapy duration; ongoing trials (e.g., MASTER, DRAMMATIC) are evaluating stopping rules based on sustained MRD negativity, but these do not currently apply to MRD-positive patients.
🧠 Summary:
If a myeloma patient is not MRD-negative, they should generally continue Revlimid maintenance therapy indefinitely, or until:
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The disease progresses,
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Side effects become unmanageable,
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Or another clinical reason warrants stopping.
While low-dose maintenance therapy has been shown to enhance both PFS and OS (the patient’s first remission as well as the patient’s length of life), I am quick to add that there are many evidence-based non-conventuonal therapies that MM patients should consider.
I am a long-term MM survivor. Email me at David.PeopleBeatingCancer@gmail.com if you’d like to learn more about both conventional and non-conventional MM therapies.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Sustained bone marrow and imaging MRD negativity for 3 years drives discontinuation of maintenance post-ASCT in myeloma
Key Points
- The TFS rate at 36 months after lenalidomide maintenance discontinuation was 75.8% (95% confidence interval, 64-90).
- Of the 12 patients who reversed from MRD negative to MRD positive and restarted maintenance, 4 progressed and all remained alive.
Discontinuation of lenalidomide maintenance after autologous stem cell transplantation is a burning question within the multiple myeloma (MM) community, especially after the inclusion of minimal residual disease (MRD) in the disease response criteria.
In this prospective study, we evaluated the conversion to MRD positivity, the treatment-free survival (TFS), and the progression-free survival (PFS) in 52 patients with MM who discontinued lenalidomide maintenance after achieving sustained bone marrow and imaging MRD negativity for 3 years.
Patients who developed MRD positivity after lenalidomide discontinuation restarted lenalidomide maintenance at the same dose. The median follow-up from lenalidomide discontinuation was 3 years.
Overall, 12 (23%) patients obtained MRD positivity and restarted lenalidomide maintenance. Only 4 (7.6%) patients progressed; 3 had a biochemical progression and 1 had a clinical progression. The overall median PFS was not reached, whereas the 7-year PFS from diagnosis was 90.2%.
The 1-, 2-, and 3-year TFS rates were 93.9%, 91.6%, and 75.8%, respectively, whereas the 1-, 2-, and 3-year landmark PFS rates from maintenance discontinuation (study entrance) were 96.0%, 96.0%, and 92.9%, respectively.
There were no statistically significant associations among age, sex, Second Revision International Staging System, type of induction therapy, and use of consolidation therapy and the effect outcomes of PFS and TFS.
We conclude that maintenance discontinuation after 3 years of sustained marrow and imaging MRD negativity is associated with low rates of MRD conversion and progressive disease.
Thus, in the era of modern antimyeloma treatments, a subgroup of patients may remain treatment free while in complete remission without jeopardizing disease response.
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