Selecting the Proper Maintenance Therapy

Selecting the Proper Maintenance Therapy

Maintenance therapy approaches remain non-standardized and vary significantly between centers, influenced by available clinical trials and institutional preferences. For standard-risk patients, options include single-agent lenalidomide versus lenalidomide plus daratumumab, with some centers offering clinical trial enrollment comparing these approaches. High-risk patients typically receive more intensive maintenance, ranging from additional consolidation cycles of quadruplet therapy to enrollment in trials investigating novel maintenance strategies.

Clinical trial availability significantly influences maintenance decisions, particularly for high-risk disease, though older trial designs with single-agent lenalidomide control arms no longer reflect optimal standard practice. The daratumumab maintenance approach when used outside trials is often modified from trial protocols based on individual patient needs. Patient preference and logistical considerations, including distance to treatment centers and desire for treatment breaks, factor into maintenance planning.

Collaboration with community oncologists for maintenance delivery requires clear communication and support, particularly when implementing doublet or triplet maintenance regimens unfamiliar outside academic centers. Some centers maintain oversight by providing treatment protocols to community sites and seeing patients every three months for monitoring. For patients willing to continue treatment, convenience and tolerance guide decisions, with options to see patients at three-month intervals with ongoing lenalidomide or continue more intensive regimens based on risk stratification and response.