What is the Benefit of Maintenance Therapy with Lenalidomide or Bortezomib after Autologous Stem Cell Transplantation in Multiple Myeloma and What is the Risk of Developing a Secondary Primary Malignancy?

Abstract

An otherwise healthy 60-year-old male was diagnosed with stage II multiple myeloma by the International Staging System characterized by anemia, diffuse lytic bone lesions, IgG kappa paraproteinemia, 45% bone marrow plasmacytosis and the t(4;14) by FISH and conventional cytogenetics. The patient had a very good partial remission with initial induction therapy consisting of four 3-week cycles of bortezomib 1.3 mg/m 2 IV on days 1, 4, 8, and 11 plus dexamethasone 40 mg days 1-4 (all cycles), followed by a cyclophosphamide and G-CSF mobilized melphalan 200 mg/m 2 autologous stem cell transplantation (ASCT) and experienced minimal side effects. He is doing well 60 days post-ASCT and is in a near complete remission. His oncologist recommends maintenance therapy with lenalidomide or bortezomib, but the patient is concerned about the increased risk of developing a secondary malignancy (SM), and because he has had such an encouraging response to induction therapy, he wonders if he could remain off therapy.

Minimal effect of bortezomib in reducing anti‐pig antibodies in human leukocyte antigen‐sensitized patients: a pilot study

“…In patients with multiple myeloma, bortezomib successfully inhibits proteasomes, resulting in apoptosis of plasma cells and prolongation of survival . More recently, treatment with bortezomib has been advocated to reduce anti‐HLA antibodies in patients with pre‐existing sensitization to potential allografts or in those with an allograft undergoing antibody‐mediated rejection .…”

“…Bortezomib (Velcade; Millenium Pharmaceuticals, Cambridge, MA, USA) is a proteasome inhibitor that has been approved by the United States Food and Drug Administration (FDA) for the treatment of patients with multiple myeloma . Proteasome inhibition results in apoptosis of plasma cells; its mechanisms of action have been reviewed .…”

“…Bortezomib (Velcade; Millenium Pharmaceuticals, Cambridge, MA, USA) is a proteasome inhibitor that has been approved by the United States Food and Drug Administration (FDA) for the treatment of patients with multiple myeloma [1][2][3][4].…”