What is the standard treatment for newly diagnosed patients with multiple myeloma (MM) who are not transplant candidates?

Updated: May 11, 2021
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

All of the regimens used in transplant candidates may be used in patients who are not being considered for transplantation. Other regimens, however, can only be used in patients who will not be undergoing transplantation, as they impair stem cell reserve.

The gold standard has been the MP regimen since as far back as the 1950s. This regimen typically consists of melphalan 9 mg/m2 and prednisone 100 mg given on days 1-4, with courses repeated at 4- to 6-week intervals for at least 1 year. A meta-analysis of 4930 patients from 20 randomized trials compared MP with other drug combinations and showed a significantly higher response rate (60%) with this combination, with a response duration of 18 months; however, no evidence of any difference in mortality was found between MP and other drug combinations. [67]


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