What are the NCCN recommended chemotherapy regimens for the treatment of multiple myeloma (MM)?

Updated: Jul 15, 2019
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The NCCN considers the following regimens useful in certain circumstances (eg, two-drug regimens may be appropriate for elderly or frail patients):

  • Bortezomib/dexamethasone (category 1)
  • Bortezomib/thalidomide/dexamethasone (category 1)
  • Lenalidomide/dexamethasone (category 1)
  • Dexamethasone/thalidomide/cisplatin/doxorubicin/cyclophosphamide/etoposide/bortezomib (VTD-PACE)

For primary induction therapy in patients who are not transplant candidates, the NCCN guidelines list the following as preferred regimens [2] :

  • Bortezomib/lenalidomide/dexamethasone (category 1)
  • Lenalidomide/low-dose dexamethasone (category 1)
  • Daratumumab/bortezomib/melphalan/prednisone (category 1) 
  • Bortezomib/cyclophosphamide/dexamethasone

Other NCCN-recommended regimens for these cases include the following:

  • Carfilzomib/lenalidomide/dexamethasone
  • Carfilzomib/cyclophosphamide/dexamethasone
  • Ixazomib/lenalidomide/dexamethasone

For maintenance therapy, the NCCN recommends lenalidomide (category 1); bortezomib may also be used.


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