The Fellow on Call: The Heme/Onc Podcast Episode 149: Myeloma Series, Pt. 9 - Maintenance for Multiple Myeloma (2026)
Mar 18, 2026
Discussion of maintenance strategies after transplant for multiple myeloma, focusing on lenalidomide as standard care. Debate over adding anti‑CD38 antibodies like daratumumab and trial evidence for combined approaches. Use of MRD to guide treatment duration and stopping rules. Special considerations and intensified plans for high‑risk patients.
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Why Lenalidomide Is The Maintenance Standard
- Lenalidomide (Revlimid) became standard maintenance after meta-analysis showed improved overall survival when pooling three RCTs.
- Seven-year OS was 62% with lenalidomide versus 50% without, but second primary malignancies rose (hematologic 6% vs 3%, solid 7% vs 4%).
Daratumumab Alone Adds Little After Deep Remission
- Cassiopeia showed daratumumab maintenance barely improved PFS versus observation after quad induction and had no OS benefit at 80-month follow-up.
- The VTD arm that later received daratumumab in maintenance matched outcomes of upfront daratumumab, suggesting timing matters more than continuous use.
Perseus Supports Time Limited Daratumumab
- In Perseus, patients who received daratumumab in induction continued daratumumab plus lenalidomide for two years then stopped daratumumab if sustained MRD-negative for 12 months.
- About 64% came off daratumumab at two years and continued lenalidomide alone.