Consolidation and maintenance in de novo first-line multiple myeloma with modern agents

SUMMARY  Inclusion of new active drugs, such as IMiDs, proteasome inhibitors and soon the monoclonal antibodies, in first-line therapy has and will significantly enhance the response rate and depth of response, with the consequence of prolongation of the progression free and overall survivals. One of the greatest challenges faced in myeloma in recent years was to demonstrate the impact of prolonged therapy in the form of consolidation and/or maintenance. To date, this concept has almost always improved duration of response and progression free survival, but infrequently overall survival. Furthermore, this concept is associated to a certain cost, with not always predictable mid- and long-term adverse events along with the economic cost accompanying these events. As patients with myeloma live significantly longer, physicians need to discuss the risk/benefit of this approach at the individual level, and remain aware of the potential consequences as more knowledge becomes available.