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

Updated: Mar 06, 2020
  • 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
  • Ixazomib/cyclophosphide/dexamethasone
  • Bortezomib/thalidomide/dexamethasone (category 1)
  • Cyclophosphamide/lenalidomide/dexamethasone
  • Dexamethasone/thalidomide/cisplatin/doxorubicin/cyclophosphamide/etoposide/bortezomib (VTD-PACE)

In September 2019 the US Food and Drug Administration approved the combination of bortezomib/thalidomide/dexamethasone with daratumumab for newly diagnosed young patients with MM who are eligible for transplantation.

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

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

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


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