By Jennifer Hinkel, MSc, Newsletter Editor-in-Chief and Edward Li, PharmD, BCOP, Drugs and Biologics Editor
Data from an NCCN Trends™ survey shows that clinicians vary in their approaches to using maintenance therapy in patients with multiple myeloma after an autologous stem cell transplant. According to this survey, which was conducted in February 2010, 37% of responding clinicians "usually consider maintenance therapy as the preferred strategy" for this patient group, while 34% "usually consider observation as the preferred strategy but consider maintenance therapy for patients who want active treatment."
For the February survey, 905 respondents participated, with 71% of the respondents identifying themselves as practicing physicians in a cancer specialty. An additional 11% were advanced practitioners or nurses in oncology, and 6% were pharmacists specializing in oncology. The survey included questions on practice patterns in multiple myeloma and chronic lymphocytic leukemia (CLL).
Of the practicing clinicians who participated in the survey, 575 treated patients with multiple myeloma. Respondents were asked to identify the scenario that best described their use of maintenance therapy for patients with multiple myeloma who are status post (s/p) autologous stem cell transplant (auto SCT) with stable disease out of four possible scenarios. Opinions appeared to be divided, with 37% responding “I usually consider maintenance therapy as the preferred strategy for most or all of these patients” but 34% responding “I usually consider observation as the preferred strategy for most or all of these patients, but I consider maintenance therapy for patients who want active treatment.” Another 17% responded “I usually consider a second tandem transplant as the preferred strategy for most or all of these patients, but I consider maintenance therapy for patients who cannot tolerate a tandem transplant.” The remaining 11% selected “I usually do not consider maintenance therapy as an option in most or all of these patients.”
The next survey question asked about preferred maintenance therapy for most patients with multiple myeloma who are s/p auto SCT. Lenalidomide was the most frequently selected choice (42%), while thalidomide was selected by 34% of respondents. Twelve percent selected “thalidomide and prednisone.”
The remaining two survey questions focused on treatment options for chronic lymphocytic leukemia (CLL), specifically for patients with del (17p) with >20% cells. For this patient group, a majority (58%) of the responding clinicians who treat CLL selected FCR (fludarabine, cyclophosphamide, rituximab) as their preferred choice for first-line therapy. However, for the same patient population, clinicians’ preferred choices for relapsed/refractory therapy indicated a wider difference of practice, with 29% selecting bendamustine, 21% selecting CHOP + rituximab, and 19% selecting alemtuzumab + rituximab. The other choices, including CFAR, HyperCVAD + rituximab, ofatumumab, high-dose dexamethasone, and OFAR were selected less frequently (each by fewer than 10% of responding clinicians).