Which induction therapy regimens are used for primary therapy in patients with multiple myeloma who are transplant candidates?

Updated: Aug 14, 2019
  • Author: Sara J Grethlein, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Patients who present with active (symptomatic) multiple myeloma are treated with induction therapy. [13] Any one of the combination regimens below may be used for induction therapy.

Lenalidomide (Revlimid)/bortezomib/dexamethasone (VRd, RVd)  [5]  

  • Bortezomib 1.3 mg/m 2 IV push (IVP) on days 1, 4, 8, and 11  plus   lenalidomide 25 mg PO daily on days 1-14  plus   dexamethasone 20 mg PO daily on days 1, 2, 4, 5, 8, 9, 11, and 12  or dexamethasone 40 mg PO daily on days 1, 8, and 15; 21-d cycle for three or four cycles
  • Subcutaneous administration of bortezomib can be considered when neuropathic adverse effects are a concern.

Daratumumab/bortezomib/thalidomide/dexamethasone (dara-VTD)  [4]  :

  • Bortezomib 1.3 mg/m SC on days 1, 4, 8, and 11  plus   thalidomide 100 mg PO daily  plus  oral or intravenous dexamethasone (40 mg on days 1, 2, 8, 9, 15, 16, 22, and 23 of cycles one and two; 40 mg on days 1 and 2 of cycles three and four; 20 mg on days 8, 9, 15, and 16 of cycles three and four  plus   daratumumab 16 mg/kg IV weekly in cycles one and two and once every 2 weeks during induction cycles three and four; 28-d cycle for four cycles

Bortezomib/cyclophosphamide/dexamethasone (CyBorD, VCD)

This combination is preferred for patients with acute renal insufficiency. It may be used in any of the following regimens [14, 15, 16] :

  • Bortezomib 1.3 mg/m2 IVP on days 1, 4, 8, and 11 plus  cyclophosphamide 300 mg/m2/day PO on days 1, 8, 15, and 22 plus dexamethasone 40 mg PO daily on days 1-4, 9-12, and 17-20; 28-d cycle for three or four cycles

  • Bortezomib 1.3 mg/m2 IVP on days 1, 4, 8, and 11 plus  cyclophosphamide 500 mg/m2/day PO on days 1, 8, and 15 plus dexamethasone 40 mg PO daily on days 1, 8, and 15; 21-d cycle for three or four cycles

  • Bortezomib 1.3 mg/m2 IVP on days 1, 4, 8, and 11 plus  cyclophosphamide 900 mg/m2 IV over 1 h on day 1 plus dexamethasone 40 mg PO daily on days 1 2, 4, 5, 8, 9, 11, and 12; 21-d cycle for three or four cycles

Bortezomib/doxorubicin/dexamethasone

Either of the following two regimens may be used [17, 18] :

  • Bortezomib 1.3 mg/m2 IVP on days 1, 4, 8, and 11 plus  doxorubicin 9 mg/m2 IV push on days 1-4 plus dexamethasone 40 mg PO daily on days 1-4, 8-11, and 15-18 (cycle 1), then days 1-4 (cycles two-four); 21-d cycle for three or four cycles

  • Bortezomib 1.3 mg/m2 IVP on days 1, 4, 8, and 11 plus  doxorubicin 9 mg/m2 continuous IV infusion over 24 h daily on days 1-4 plus dexamethasone 40 mg PO daily on days 1-4, 9-12, and 17-10; 28-d cycle for three or four cycles

Bortezomib/lenalidomide/dexamethasone

Bortezomib 1.3 mg/m2 IVP on days 1, 4, 8, and 11 plus  lenalidomide 25 mg PO daily on days 1-14 plus  dexamethasone 20 mg PO daily on days 1, 2, 4, 5, 8, 9, 11, and 12 or 40 mg PO daily on days 1, 8, and 15; 21d cycle for three or four cycles [19, 20]

Bortezomib/thalidomide/dexamethasone

Bortezomib 1-1.3 mg/m2 IVP on days 1, 4, 8, and 11 plus  thalidomide 50-200 mg (titrate to tolerance) PO daily at bedtime on days 1-21 plus  dexamethasone 40 mg PO daily on days 1, 2, 4, 5, 8, 9, 11, and 12 or  40 mg on days 1-4 and 9-12 or 40 mg on days 1-4 and 8-11; 21d cycle for three or four cycles [21, 22]

Lenalidomide/dexamethasone

Either of the following two regimens may be used [23, 24] :

  • Lenalidomide 25 mg PO daily on days 1-21 plus dexamethasone 40 mg PO daily on days 1, 8, 15, and 22 or 40 mg PO daily on days 1-4, 9-12, and 17-20; 28-d cycle for three or four cycles

  • Lenalidomide 25 mg PO daily on days 1-28 plus dexamethasone 40 mg PO daily on days 1-4, 9-12, and 17-20; 28-d cycle for three or four cycles


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