Learn about all myeloma happenings on the new Myeloma Crowd site: the first comprehensive site for myeloma patients and caregivers. Dr. Antonio Palumbo, MD University of Torino, Italy Interview Date: August 25, 2014

 Dr. Antonio Palumbo, MD of the University of Torino, Italy discusses his ASCO 2014 findings showing that continuous maintenance therapy can give on average an additional year of benefit for most myeloma patients. He notes that if patients have minimal residual disease, that continuing maintenance can help keep the myeloma down, improving their remission status over time. He cautions that even though patients may achieve a stringent complete response, it doesn't mean they are disease-free because there is always residual tumor. He wondered if giving continuous maintenance after the first remission would negate any benefit by making the myeloma come back in the second remission more aggressively, but found this wasn't the case;  it still provided a year of benefit. He shares that only about 20% of patients will become refractory to the treatment with extended use. Dr. Palumbo describes when to stop continuous maintenance - when toxicities are above a grade 1 or whenever the patient feels that they are too much for an acceptable quality of life. Dr. Palumbo shares that Revlimid and bortezomib have been used as maintenance and both have shown the year benefit, although there have been no head-to-head comparisons between the two. He notes that out of all the indicators that may influence outcomes like disease biology and the patient response, the best indicator for outcomes is the duration of response. If patients have a longer response, they will have better overall outcomes regardless of remission status. He describes that with the wide variety of newer myeloma treatments, patients are now having not one or two remissions, but four, five or six remissions and while this is great news for patients, it makes understanding the impact of continuous maintenance more complicated to calculate. The live mPatient Myeloma Radio podcast with Dr. Antonio Palumbo, MD