Optimal treatment strategies in myeloma: An argument against maintenance therapy after autologous stem cell transplantation

Despite continuing advancements in novel therapeutics for multiple myeloma (MM), high-dose therapy with autologous stem cell rescue continues to represent the standard approach to treat transplant-eligible, newly diagnosed patients. As the disease remains essentially incurable, and median progression-free survival (PFS) times after autologous transplant are measured in years and not decades, attempts to improve outcomes in the post-transplant setting have been extensive and commonly focused on a “maintenance” approach. Although multiple trials have demonstrated PFS advantages for a variety of maintenance strategies, it is our position that the potential risks outweigh the benefits of this approach and this should not be the standard of care outside of clinical trials.