O papel da terapia de manutenção no mieloma múltiplo

Abstract

The use of maintenance therapy for patients with multiple myeloma (MM) and complete or almost complete remission is still under discussion. Although not curative, high dose chemotherapy followed by autologous bone marrow transplantation significantly prolongs overall survival time. The addition of maintenance therapy seems to be a valuable alternative aiming at longer inactive disease periods (plateau) or even as an effective therapy for minimal residual disease. It may also bring higher rates of complete response to patients with an initial partial response. Over more than two decades, maintenance therapy for MM has been discussed and proposed. Since then various drugs and their combinations have been studied for this purpose, such as interferon-alpha, glucocorticoids - including dexamethasone and prednisone - and the more recently antiangiogenic drugs including thalidomide and its analogs. Clinical trials with each of these agents have shown advantages and, sometimes, disadvantages in terms of disease-free survival, overall survival and toxicity. A general review of these studies draws attention to the lack of evidence favoring unequivocal benefits in overall survival. In a time when novel and promising therapies arrive we shall emphasize the need of individual therapeutic approaches in terms of maintenance therapy, considering the prognosis and risk factors of each patient.