Treatment of 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 cannot proceed to high-dose therapy or autologous stem cell transplantation (ASCT). Approximately one-third of patients are older than 75 years at diagnosis and at least 30% are frail — making tailored, transplant-ineligible protocols essential.
Clinical scenario: Newly diagnosed multiple myeloma in a patient who is not eligible for high-dose therapy and autologous stem cell transplantation. Recognised standards of care exist specifically for this population, distinct from transplant-eligible pathways.
Treatment approach: The protocol defines established first-line standards for transplant-ineligible patients, as well as structured guidance for later lines — including options for patients refractory to commonly used agents and those with specific disease characteristics. The complete regimen selection criteria, sequencing, and eligibility conditions are contained in the full structured 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.
- For patients who have been exposed or are refractory to both bortezomib and lenalidomide, DaraKd [I, A], IsaPd [I, A], IsaKd [I, A] and EloPd [II, B] are recommended.
- Patients with t(11;14), who are refractory to lenalidomide and are PI-sensitive may be treated with VenVd [I, A], if available.
- For triple-class refractory patients, Sd or belantamab mafodotin monotherapy is recommended [II, B], if available.
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