Newly Diagnosed Multiple Myeloma Not Eligible for High-Dose Therapy or Autologous Stem Cell Transplantation
A substantial proportion of patients with newly diagnosed multiple myeloma are not candidates for high-dose chemotherapy and autologous stem cell transplantation (ASCT). This group — which includes many older and frail patients — requires a distinct first-line treatment strategy.
Clinical scenario
Newly diagnosed multiple myeloma in a patient who is not eligible for high-dose therapy and autologous stem cell transplantation. Notably, one-third of patients with multiple myeloma are older than 75 years at diagnosis, and at least 30% are frail — factors that frequently preclude transplant eligibility.
Treatment approach (partial overview)
Several evidence-based first-line regimen options are available for transplant-ineligible patients, including daratumumab-based combinations and bortezomib-based combinations administered until disease progression. The selection among options — and the sequence when preferred agents are unavailable — depends on patient fitness, comorbidities, and drug availability. The complete regimen selection algorithm is available via the full protocol.
References
DOI: 10.1016/j.annonc.2020.11.014
For patients who are not eligible for ASCT, there are three new standards of care: VRd, DaraVMP and DaraRd [I, A].
It is important to realise that one-third of patients are older than 75 years at diagnosis and at least 30% are frail.
When DaraRd and DaraVMP are not available, VRd is the preferred option in fit patients; Rd and VMP may be considered for patients who cannot receive the previous regimens [I, A].
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