TOPLINE:

In multiple myeloma (MM), maintenance therapy (MT) after auto-hematopoietic stem cell transplantation (HSCT) didn’t boost progression-free survival (PFS) or overall survival (OS) in patients who achieved sustained minimal residual disease (MRD) negativity, according to an abstract presented at the American Society of Hematology (ASH).

METHODOLOGY:

• It has been unclear whether MT is necessary after patients with MM achieve MRD negativity following HSCT.
• In a prospective, randomized study, researchers tracked 196 patients aged 26-66 years who reached MRD negativity after auto-HSCT from 2014 to 2024 (median age, 54 years; 63.3% female). Patients received one auto-HSCT (72%) or tandem (28%).
• Seventy-six patients (39%) were prescribed lenalidomide (Revlimid) as MT for a fixed duration of 1 year, and 120 patients did not receive MT.
• The median follow-up was 48 months.

TAKEAWAY:

• Five-year PFS rates were comparable at 49% for the MT group (median, 81 months) and 59% for the non-MT group (median, 59 months; P > .05).
• Five-year OS rates were also comparable at 86% for the MT and 89% for the non-MT group (P > .05).
• MRD negativity response was sustained in 54 of 75 MT patients (72%) and 88 of 113 non-MT patients (78%).
• PFS in patients with sustained MRD negativity response (at least 12 months) was higher at 104 months than at 26 months in those without sustained negativity response (P < .001).
• Five-year OS was significantly higher in patients with sustained MRD negativity response (at least 12 months) at 95% than 70% in those without sustained negativity response (P < .001).

IN PRACTICE:

“The omission of lenalidomide maintenance therapy did not worsen the prognosis or survival parameters in patients with an MRD-negative response after autologous HSCT,” study co-author told Medscape Medical News. “Our study is one of the first in the world to demonstrate the feasibility of omitting maintenance therapy after autologous HSCT if MRD negativity is achieved.”

SOURCE:

The study, led by Maksim V. Solovev, MD, PhD, National Medical Research Center for Hematology, Moscow, Russian Federation, was presented at the American Society of Hematology (ASH) 2025 Annual Meeting.

LIMITATIONS:

The study was based on data from a single center.

DISCLOSURES:

The study reported receiving no funding. Study authors reported having no disclosures.