Treatment of Newly Diagnosed Multiple Myeloma in Patients Under 70 with No Comorbidities
Clinical Scenario
This protocol addresses fit patients with newly diagnosed multiple myeloma (NDMM) who are under 70 years of age, have no significant comorbidities, and are eligible for high-dose therapy (HDT) and autologous stem cell transplantation (ASCT).
Recommended Approach
For fit NDMM patients aged under 70 without comorbidities, induction therapy followed by high-dose therapy with autologous stem cell transplantation and subsequent maintenance is the established treatment pathway.
At first relapse, the choice of salvage strategy depends on what was used in the initial line, the duration of the prior response, and specific disease characteristics — multiple distinct approaches are defined in the structured protocol.
The complete sequence, eligibility criteria, and regimen options are available in the full protocol.
References
DOI: 10.1016/j.annonc.2020.11.014
- For fit NDMM patients, aged <70 years, without comorbidities, induction followed by high-dose therapy (HDT) with autologous stem cell transplantation (ASCT) and lenalidomide maintenance is the recommended treatment.
- Second-line ASCT is an option for patients who received primary therapy that included an ASCT followed by lenalidomide maintenance and had an initial remission duration of 36 months (panel consensus).
- Patients who had received a bortezomib-based therapy upfront without lenalidomide or Dara should receive an Rd-based regimen, i.e. KRd, DaraRd, IRd or EloRd [I, A].
- Patients who are refractory to lenalidomide upfront could receive either PomVD, DaraKd, IsaKd or DaraVd [I, A].
- VenVd is a suitable option for patients with t(11;14) who have failed lenalidomide and are sensitive to PIs [I, A], if available.
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