Part II: role of maintenance therapy in transplant-ineligible patients

Many advances were made in the treatment of multiple myeloma since the introduction of the immunomodulatory drugs thalidomide and lenalidomide and the proteasome inhibitor bortezomib. An increasing number of clinical trials have examined consolidation/maintenance therapy as part of a sequential approach after induction therapy and demonstrated benefit in patients eligible and ineligible for transplantation. This outcome improvement reported with consolidation/maintenance therapy should be balanced against the toxicity profile, and prompt management of adverse events is necessary. This article provides an overview of the main trials including consolidation/maintenance therapy after induction for transplant-ineligible patients. Recommendations on how to manage treatment-related toxicities are also provided.