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

Updated: May 11, 2021
  • 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 (although triplet regimens should be used as the standard, patients not considered candidates for a 3-drug regimen can be started on a 2-drug regimen, with the third drug added once performance status improves):

  • Bortezomib/doxorubicin/dexamethasone
  • Carfilzomib/cyclophosphamide/dexamethasone (Option for patients with renal insufficiency and/or peripheral neuropathy)
  • Ixazomib/cyclophosphamide/dexamethasone (Option for patients with renal insufficiency and/or peripheral neuropathy)
  • Bortezomib/thalidomide/dexamethasone (category 1)
  • Cyclophosphamide/lenalidomide/dexamethasone
  • Dexamethasone/thalidomide/cisplatin/doxorubicin/cyclophosphamide/etoposide/bortezomib (VTD-PACE) (reserved for treatment of aggressive multiple myeloma)

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)
  • Daratumumab/lenalidomide/dexamethasone (category 1)
  • Lenalidomide/low-dose dexamethasone (category 1)
  • Bortezomib/cyclophosphamide/dexamethasone (Preferred initial treatment in patients with acute kidney injury (consider switching to bortezomib/lenalidomide/dexamethasone after kidneyfunction improves) or without access to lenalidomide

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

  • Carfilzomib/lenalidomide/dexamethasone
  • Ixazomib/lenalidomide/dexamethasone
  • Daratumumab/bortezomib/melphalan/prednisone (category 1)
  • Daratumumab/cyclophosphamide/bortezomib/dexamethasone

The following are useful in certain circumstances:

  • Bortezomib/dexamethasone
  • Carfilzomib/cyclophosphamide/dexamethasone (Option for patients with kidney failure and/or peripheral neuropathy)
  • Cyclophosphamide/lenalidomide/dexamethasone

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


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