Multiple myeloma is a type of blood cancer that starts in the bone marrow, where plasma cells become cancerous. While treatments like chemotherapy and stem cell transplants can push the disease into remission, it doesn’t mean the cancer is gone for good. That’s where maintenance therapy comes in—it’s a way to keep the disease under control for as long as possible.
What Is Maintenance Therapy for Multiple Myeloma?
Maintenance therapy for Multiple Myeloma involves taking ongoing, lower-dose medications after your initial treatment. The goal is to keep the cancer in remission (where there are no signs of active disease), prevent relapse, and improve survival. For many patients, this is especially important after a stem cell transplant, but it can also be used even if you haven’t had one.
Multiple Myeloma Maintenance Therapy Options
There are several types of medications used for maintenance therapy. Each works in a slightly different way, and your doctor will recommend one based on your specific situation:
Lenalidomide
Lenalidomide is one of the most commonly prescribed drugs for maintenance therapy. It helps the immune system fight cancer cells and keeps them from growing. Studies show it can significantly delay the return of multiple myeloma, sometimes by years. However, it can come with side effects like fatigue, diarrhea, or a higher risk of infections. There’s also a slightly increased risk of developing another cancer later, which your doctor will monitor closely.
Bortezomib (Velcade)
This drug targets the protein systems that cancer cells rely on to survive. Bortezomib is especially effective for patients with high-risk types of myeloma. Side effects may include nerve pain (neuropathy), which can sometimes be managed by adjusting the dose.
Thalidomide (Thalomid)
Thalidomide is similar to lenalidomide but is used less often due to its side effects, such as numbness or tingling in the hands and feet (neuropathy).
Corticosteroids (like dexamethasone)
These drugs are sometimes added to maintenance therapy to reduce inflammation and stop the growth of cancer cells. Long-term use can lead to side effects like weight gain, high blood sugar, or weakened bones, so careful monitoring is important.
Why Is Maintenance Therapy Important?
Think of maintenance therapy as a way to “stay ahead” of multiple myeloma. Even if there are no obvious signs of the disease after initial treatment, tiny amounts of cancer cells can still linger in the body.
Without maintenance therapy, these cells can grow and cause a relapse.
Research shows that maintenance therapy can significantly increase the time patients remain in remission and even improve overall survival.
For example, studies show that patients on lenalidomide after a stem cell transplant can have up to 50% longer remission periods compared to those who don’t take it. In some cases, combining drugs like lenalidomide with bortezomib has been shown to further improve outcomes.
How Long Does Maintenance Therapy Last?
The length of maintenance therapy depends on several factors, including how well you’re tolerating the treatment and how effective it is. For most patients, maintenance therapy is prescribed for at least one to three years. Some continue treatment longer if it’s working well and side effects are manageable.
A recent study found that patients who stayed on maintenance therapy for more than two years had better outcomes than those who stopped earlier. However, this decision is personal and should be made in collaboration with your doctor.
What Are the Challenges of Maintenance Therapy?
Maintenance therapy is often easier to tolerate than the intensive treatments used to get the disease into remission, but it still has its challenges. The most common side effects include:
- Fatigue: Feeling unusually tired is a common issue during maintenance therapy. This happens because many of the drugs used, like lenalidomide, affect your bone marrow, where blood cells are made. Lower levels of red blood cells (anemia) can reduce the oxygen reaching your tissues, leading to fatigue. The body also uses a lot of energy to recover from the disease and treatment, which can add to the feeling of exhaustion.
- Digestive issues: Drugs like lenalidomide can irritate the lining of your gastrointestinal tract, affecting how your gut absorbs and processes food. This irritation can speed up or slow down digestion, causing diarrhea or constipation.
- Infections: Medications like lenalidomide and bortezomib can suppress your bone marrow, where white blood cells (which fight infections) are produced. With fewer white blood cells, your immune system is weaker, leaving you more vulnerable to infections. Your doctor may monitor your blood counts regularly and recommend steps like vaccines or preventive antibiotics to reduce this risk.
- Nerve pain (neuropathy): Neuropathy—tingling, numbness, or pain in your hands and feet—can occur with drugs like bortezomib and thalidomide. These medications can damage the nerves, particularly the small sensory fibers that carry signals from your extremities to your brain. This side effect often depends on the dose and length of treatment, and it can sometimes improve with dose adjustments.
Open communication with your healthcare team is the best way to manage these side effects. They can adjust doses or switch medications if needed to make treatment more comfortable.
The Bottom Line
Maintenance therapy is an essential part of living with multiple myeloma.
While it doesn’t cure the disease, it can help you stay in remission longer, reduce the chance of relapse, and improve your overall quality of life. Every patient’s journey is different, so it’s important to work closely with your doctor to find the right treatment plan for you.
Ongoing research is constantly improving these therapies, bringing hope to patients with multiple myeloma and their families. If you’re unsure about your options or have questions about side effects, don’t hesitate to reach out to your healthcare team—they’re there to support you every step of the way.