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Data from a large phase III trial presented at the 2022 American Society of Hematology (ASH) annual meeting examined the relationship between minimal residual disease, progression-free survival, and overall survival in patients randomly assigned to lenalidomide maintenance or no maintenance at 3 months after autologous stem-cell transplant.

In this exclusive 番茄社区app video, study author , of NYU Langone's Perlmutter Cancer Center in New York City, discusses the clinical takeaways from .

Following is a transcript of his remarks:

One of the most important questions in myeloma these days is how long you should continue maintenance for. I mean, I'm gonna say five studies and a meta-analysis showed that maintenance Revlimid (lenalidomide) improves progression-free survival and also seems to improve overall survival. So it's an approved regimen.

But when you think about where we are going in terms of myeloma treatment these days and the outcomes we get, the median progression-free and overall survival can be somewhere between 7 to 10 years. So that's a long time to commit to a treatment if you're treating to progression. So we're going to start to see a set of studies that investigate when you start stopping the maintenance. And so kind of designing those studies is nightmarish because there's nothing really to go on.

And so what we kind of thought was, we did this study, it has like 1,500 patients who were all on treatment for a prolonged period of time. And so we did a set of landmark analyses to see what happened if you were continued beyond at a certain time point.

And the bottom line was that overall at all of the cut points, you should continue treatment to at least 4 years. But then we started to try and be a bit more clever and say, if you've got high-risk disease, how long should you continue for? And for them it looked like 2-and-a-half to 3 years. For lower-risk disease, they benefited out to 4 years.

And so then you can look at people who have no evidence of disease or that sustained no evidence, and for those patients even, they benefit from substantially long treatment out to about 4 years. So if you've got detectable disease probably beyond 4 years, if there's nothing there and it's sustained negative, probably for 3 years.

What it means for me is, I kind of seen a load of patients to date is, that I've made kind of judgment in my head to treat to 2 years and stop maintenance across the board. A lot of clinicians have made the decision to treat out until progression, which I think is going to bring with it side effects.

And so I think it looks like about the average amount of treatment should be somewhere between 3 to 4 years. And if you were going to design trials going forward, that would be a good cut point to assess.

The other thing I think is that's important is people are stopping when there's no detectable disease. And so even at a year, patients who are negative, there are trials that look at stopping. And what this says that that's probably not serving the patients well, and you should continue at least another 2 years from that time point.

So lots of anecdotal advice for what to do, but I guess the message is people will design clinical trials.

Watch episode one of this series: Elranatamab Active in Relapsed or Refractory Multiple Myeloma

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