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Multicenter Study
. 2025 Feb 5;25(1):204.
doi: 10.1186/s12885-025-13518-0.

Real-world outcomes of maintenance therapy post-autologous stem cell transplantation in newly diagnosed multiple myeloma

Ka-Won Kang  1 , Dae Sik Kim  2 , Se Ryeon Lee  3 , Mi Hwa Heo  4 , Hyeon-Seok Eom  5 , Jongheon Jung  5 , Ji Hyun Lee  6 , Sung-Hyun Kim  6 , Youngil Koh  7 , Chang-Ki Min  8 , Seung Shin Lee  9 , Sung-Nam Lim  10 , Ho-Young Yhim  11 , Myung-Won Lee  12 , Je-Jung Lee  13 , Sung-Hoon Jung  13 , Soo-Mee Bang  14 , Kihyun Kim  15 ; Korean Multiple Myeloma Working party [KMMWP]
Affiliations
Multicenter Study

Real-world outcomes of maintenance therapy post-autologous stem cell transplantation in newly diagnosed multiple myeloma

Ka-Won Kang et al. BMC Cancer. .

Abstract

Background: In the Republic of Korea, only lenalidomide, bortezomib, ixazomib, and thalidomide monotherapy are available as maintenance therapy post-autologous stem cell transplantation (ASCT).

Methods: To determine whether maintenance therapy confers a survival benefit in the real world, we compared treatment outcomes according to the use and type of maintenance therapy in patients who underwent ASCT following frontline therapy with the triplet regimen of bortezomib, thalidomide, and dexamethasone for newly diagnosed multiple myeloma in 15 nationwide centers.

Results: A total of 512 patients were analyzed (no-maintenance group, n = 359, and maintenance group, n = 153 patients). Among those receiving maintenance therapy, 104 (68%) received thalidomide, 33 (21%) lenalidomide, and 16 (10%) bortezomib or ixazomib. The median progression-free survival (PFS) from the time of ASCT was 26.4 and 44.1 months in the no-maintenance and maintenance groups, respectively. In the multivariate analysis, the use of maintenance therapy was significantly associated with better PFS. After adjustment for the type and duration of maintenance therapy, the use of bortezomib or ixazomib was associated with better PFS than other drugs. Longer duration of therapy was associated with improved PFS. No statistically significant difference was observed in overall survival and secondary malignancy rates by use or type of maintenance.

Conclusion: Despite practical limitations, maintenance therapy after ASCT demonstrated a gain in PFS in the real world, and there was no clear increase in the risk of secondary malignancy. Therefore, it may be prudent to consider implementing maintenance therapy in a feasible manner.

Keywords: Autologous stem cell transplantation; Bortezomib; Ixazomib; Lenalidomide; Maintenance; Multiple myeloma; Thalidomide.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (IRB) of each medical center; all data were completely anonymized. As this study was conducted using anonymous patient data, the requirement for informed consent was waived following the regulations of each medical center's IRB (Korea University Anam Hospital: 2021AN0410; Korea University Guro Hospital: 2025GR0016; Korea University Ansan Hospital: 2024AS0320; Dongsan Medical Center: DSMC 2021–09-052; National Cancer Center: NCC2022-0087; Dong-A University Hospital: DAUHIRB-21–243; Seoul National University Hospital: H-2112–020-1280; Seoul St. Mary’s Hospital: KC22RIDI0327; Wonkwang University Hospital: WKUH IRB 2022–01-010; Haeundae Paik Hospital: 2024–12-019; Jeonbuk National University Hospital: CUH 2021–09-064; Chungnam National University Hospital: CNUH IRB 2021–09-058; Chonnam National University Hwasun Hospital: CNUHH-2023–016; Seoul National University Bundang Hospital: B-2302–812-103; Samsung Medical Center: SMC 2021–09-073). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Longitudinal response kinetics in patients receiving maintenance therapy. Abbreviations: ASCT Autologous stem cell transplantation, CR Complete response, VGPR Very good partial response, PR Partial response, MR Minimal response, SD Stable disease, PD Progressive disease
Fig. 2
Fig. 2
Progression-free survival from autologous stem cell transplant according to maintenance therapy use in study patients
Fig. 3
Fig. 3
Progression-free survival from autologous stem cell transplant according to maintenance therapy type in study patients
See this image and copyright information in PMC

References

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