Priority 7 from the Myeloma (Canada) PSP

UNCERTAINTY: How can we safely reduce, cycle, or stop the use of medications (e.g., Dexamethasone and Revlimid) to reduce the side effects of treatment and maintain control over myeloma? (JLA PSP Priority 7)
Overall ranking 7
JLA question ID 0113/7
Explanatory note Myeloma patients will often undergo frontline treatment and achieve remission. However, most patients continue to take maintenance medications indefinitely to prevent or slow down a relapse of myeloma. Many participants reported a desire to reduce the dose of their medications to decrease the side-effects, to stop taking maintenance medications when in remission, or to incorporate "treatment vacations." In particular many participants commented on the frequent use of revlimid and dexamethasone and wondered whether these treatments are always necessary and whether their dose can be adjusted to reduce the side effects of treatment while maintaining control of the disease.  

 No evidence identified

Health Research Classification System category Cancer and neoplasms
Extra information provided by this PSP
Original uncertainty examples Limiting dexamethasone dose/duration to decrease side effects ~  Impact of dose reductions of various magnitude on the outcome of therapy ~ Could the dosages of chemo be regulated so the myeloma is just kept in check? ~ When is it 'safe' to terminate maintenance chemo?  When is a drug holiday an acceptable option? ~ Can lower doses of dexamethasone still control the myeloma?  
Submitted by  Please see the PSP Engagement Summary on the JLA website 
PSP information
PSP unique ID 0113
PSP name Myeloma (Canada)
Total number of uncertainties identified by this PSP. 59  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 28 April 2021