BETA - Is upfront ASCT always preferred or can an ASCT be done at first relapse? Is it really needed?

[Music] what is the role of maintenance therapy after a transplant and why do it if I'm in a complete response maintenance therapy is meant to preserve the hopefully excellent response that patients have achieved to high-dose chemotherapy myeloma is highly treatable but still difficult to cure and so whenever we can achieve a very low burden of disease through transplant or other therapies we want to maintain that and preserve that fortunately it is quite possible to do that using low doses of a medication called a little by or Revlimid or sometimes other medications as well such as bortezomib so maintenance therapy is important there are lots of studies that have now shown that continuous therapy in myeloma can lead to prolonged periods of remission and probably improved survival but it's not for everybody everybody has a little bit different myeloma we have to risk stratify patients I have patients who do not want to take a drug every day and they have very low risk disease and after they've undergone a transplant their disease is at such a low burden that we're not worried about what's gonna happen to them for years I have other patients where that's not the case where their disease is more aggressive even if their disease burden is very low there's a good chance that their myeloma is gonna come back sooner and for those patients we definitely encourage maintenance I talk about maintenance with every patient but sometimes the patients don't want to do maintenance sometimes it has to do with cost of drugs sometimes it has to do its side effects of the pills so we make an assessment of the risk of their disease and how much more benefit that they will get with maintenance some patients the the magnitude of the benefit is much higher than others so we make a calculated decision at that point along with their physician about whether it's the right decision for them to determine the effect of maintenance therapy on the progression-free survival and overall survival of multiple myeloma patients researchers combined data from 22 randomized control trials which involved almost 10,000 myeloma patients using 15 different regimens data from this study showed that lenalidomide maintenance extended a patient's progression-free survival and overall survival compared to patients that received no maintenance therapy it also showed that whether you're high risk or low risk maintenance therapy improves your progression free and overall survival compared to groups that did not do any maintenance therapy visit health treat org where you can learn more about maintenance therapy in health care University in class 6 which is called starting myeloma treatment [Music]