Thank you for joining me and welcome to Managing Myeloma. My name is Ajay Nooka, and I am assistant professor in the Division of Bone Marrow Transplant at the Emory Winship Cancer Institute. One question that I am frequently asked is, “What are the signs that my patient is non-adherent with their maintenance therapy?” As you all know, based on the prior two phase 3 trials, the CALGB trial in the United States and IFM trial from France demonstrating uniformly the PFS benefit of lenalidomide maintenance posttransplant, the use of lenalidomide maintenance is significantly increased after transplant during the recent years. Let me talk about maintenance therapy. The maintenance agent should be able to deliver certain characteristics; #1 the ease of administration, #2 lesser toxicity, and #3 the agent should be able to exhibit efficacy. Lenalidomide became such a favorite because it is able to perform all these characteristics and it’s probably the best maintenance agent at this point. When we talk about an oral maintenance agent, it comes with a few challenges, the main one being the question of adherence. It is important to recognize the science of non-adherence so that the proper actions can be taken to gain advantages of this maintenance approach. The first red flag I have watched for is the patient having remaining pills at the end of the cycle. Pill counting, appropriate counseling with the patient, as well as a caregiver simultaneously about the natural history of myeloma and the need for the maintenance approach should probably address this problem. Other red flags that I had watched for are the calls from the pharmacy if they are unable to reach the patient or the patient not answering the pre-approval questions from the pharmacy. These are all red flags that I have watched for. If this is a consistent problem, either stopping the maintenance therapy or suggesting an alternate maintenance therapy such as bortezomib maintenance for the HOVON trial should address this problem. Thank you for viewing this activity. For additional resources, please view the other educational activities at ManagingMyeloma.com.
Reviewed on January 17, 2017 for clinical relevance.