Carfilzomib, lenalidomide, and dexamethasone maintenance for multiple myeloma: when and for whom?

In The Lancet Oncology, Dominik Dytfeld and colleagues1 report interim findings of the ATLAS study, in which they compared carfilzomib, lenalidomide, and dexamethasone with lenalidomide alone as maintenance therapy after autologous stem-cell transplantation in patients with newly diagnosed multiple myeloma. Lenalidomide is the cornerstone of maintenance therapy2–4 and alternatives, especially for patients at high risk, have been intensively studied. However, previous trials did not randomly assign patients to lenalidomide, did not lead to licensing, and did not show superiority (even with more intensive regimens).