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MP
Regimen 1
Melphalan (Alkeran) 0.15 mg/kg po qd x 7 days
Prednisone 20 mg po tid x 7 days
Q6w
Regimen 2
Melphalan (Alkeran) 0.25 mg/kg po qd x 4 days
Prednisone 2 mg/kg po qd x 4 days
Q6w Facon T et al. Dexamethasone-based regimens versus melphalan-prednisone for elderly multiple myeloma patients ineligible for high-dose chemotherapy. Blood 2006; 107:1292 (link to the article). Regimen 3
Melphalan (Alkeran) 9 mg/m2 po qd d1-4
Prednisone 60 mg/m2 po qd d1-4
Q6w x 9 cycles San Miguel JF et al. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. NEJM 2008; 359:906 (link to the article).
Dexamethasone
Dexamethasone (Decadron) 40 mg po qd d1-4, 9-12, 17-20 or d1-4 only
Q4-6w Facon T et al. Dexamethasone-based regimens versus melphalan-prednisone for elderly multiple myeloma patients ineligible for high-dose chemotherapy. Blood 2006; 107:1292 (link to the article). VAD
Vincristine 0.4 mg iv over 30 min qd d1-4
Doxorubicin (Adriamycin) 9 mg/m2 iv over 30 min qd d1-4
Dexamethasone (Decadron) 40 mg po qd d1-4, 9-12, 17-20
Q4w Segeren, CM et al. Vincristine, doxorubicin and dexamethasone (VAD) administered as rapid intravenous infusion for first-line treatment in untreated multiple myeloma. Br J Haematol 1999; 105:127 (link to the article). DVD
Pegylated liposomal doxorubicin (Doxil) 40 mg/m2 iv d1
Vincristine 2 mg iv d1
Dexamethasone (Decadron) 40 mg po qd d1-4
Q4w Hussein, MA et al. A Phase II trial of pegylated liposomal doxorubicin, vincristine, and reduced-dose dexamethasone combination therapy in newly diagnosed multiple myeloma patients. Cancer 2002; 95:2160 (link to the article). Thal/Dex
Thalidomide ((Thalomid) 100-200 mg po qd
Dexamethasone (Decadron) 40 mg po qd d1-4, 9-12, 17-20 for odd cycles and d1-4 only for even cycles q4w Rajkumar SV et al. Multicenter, randomized, double-blind, placebo-controlled study of thalidomide plus dexamethasone compared with dexamethasone as initial therapy for newly diagnosed multiple myeloma. J Clin Oncol 2008; 26:2177 (link to the article). Rajkumar SV et al. Phase III clinical trial of thalidomide plus dexamethasone compared with dexamethasone alone in newly diagnosed multiple myeloma: a clinical trial coordinated by the Eastern Cooperative Oncology Group. J Clin Oncol 2006; 24:431 (link to the article). Weber, D et al. Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. J Clin Oncol 2003; 21:16 (link to the article). Rajkumar, SV et al. Combination therapy with thalidomide plus dexamethasone for newly diagnosed myeloma. J Clin Oncol 2002; 20:4319 (link to the article).
Rev/Dex low dose
Lenalidomide (Revlimid) 25 mg po qd d1-21
Dexamethasone (Decadron) 40 mg po d1, 8, 15, 22
Q4w Rajkumar SV et al. Phase III trial of lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone in newly diagnosed multiple myeloma (E4A03): a trial coordinated by the Eastern Cooperative Oncology Group. 2007 ASCO annual meeting. LBA8025 (link to the abstract). Rev/Dex high dose
Lenalidomide (Revlimid) 25 mg po qd d1-21
Dexamethasone (Decadron) 40 mg po qd d1-4, 9-12, 17-20 for the first 4 cycles, then d1-4 only
Aspirin 81 or 325 mg po qd
Q4w until disease progression
Approved by FDA on 6/29/2006 Dimopoulos M et al. Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N Eng J Med 2007; 357:2123 (link to the article). Weber DM et al. Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. N Eng J Med 2007; 357:2133 (link to the article). Rajkumar SV et al. Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma. Blood 2005; 106:4050 (link to the article).
Rev +/- Dex
Lenalidomide (Revlimid) 30 mg po qd d1-21 q4w
Dexamethasone (Decadron) 40 mg po qd d1-4 q2w Richardson PG et al. A randomized phase 2 study of lenalidomide therapy for patients with relapsed or relapsed and refractory multiple myeloma. Blood 2006; 108: 3458 (link to the article). BiRD
Clarithromycin (Biaxin) 500 mg po bid beginning on d2 of cycle 1
Lenalidomide (Revlimid) 25 mg po qd d3-21 of cycle 1 and d1-21 of subsequent cycles
Dexamethasone (Decadron) 40 mg po d1, 2, 3, 8, 15, and 22 during cycle 1 and then qw
Q4w
ASA 81 mg po qd
Omeprazole (Prilosec) 20 mg po qd
Trimethoprim/sulfamethoxazole (Bactrim) DS 1 tab po bid 3 times a week Niesvizky R et al. BiRD (Biaxin [clarithromycin]/Revlimid [lenalidomide]/Dexamethasone) combination therapy results in high complete- and overall-response rates in treatment-naive symptomatic multiple myeloma. Blood 2008; 111:1101 (link to the article). Melphalan + Prednisone + Thalidomide regimen 1
Melphalan (Alkeran) 0.25 mg/kg/d po d1-4 q6w x 12 cycles
Prednisone 2 mg/kg/d po d1-4 q6w x 12 cycles
Thalidomide ((Thalomid) 100-400 mg po qd Facon T et al. Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomized trial. Lancet 2007; 370:1209 (link to the article).
Melphalan + Prednisone + Thalidomide regimen 2
Melphalan (Alkeran) 4 mg/m2/d po d1-7 qm x 6 cycles
Prednisone 40 mg/m2/d po d1-7 qm x 6 cycles
Thalidomide ((Thalomid) 100 mg po qd till disease progression
Prophylactic Enoxaparin 40 mg sc qd during first 4 cycles of therapy Palumbo A et al. Oral melphalan, prednisone, and thalidomide in elderly patients with multiple myeloma: updated results of a randomized, controlled trial. Blood 2008; First Edition Paper, prepublished online May 27 (link to the abstract). Palumbo A et al. Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: a randomized controlled trial. Lancet 2006; 367:825 (link to the article). Melphalan + Prednisone + Lenalidomide
Melphalan (Alkeran) 0.18 mg/kg po qd d1-4
Prednisone 2 mg/kg po qd d1-4
Lenalidomide (Revlimid) 10 mg po qd d1-21
Q4w x 9 cycles
Maintenance Lenalidomide (Revlimid) 10 mg po qd d1-21 q4w until progression
Ciprofloxacin (Cipro) 500 mg po bid for antibiotic prophylaxis
Aspirin 100 mg po qd for thrombosis prophylaxis
Palumbo A et al. Melphalan, prednisone, and lenalidomide treatment for newly diagnosed myeloma: a report from the GIMEMA-Italian Multiple Myeloma Network. J Clin Oncol 2007; 25:4459 (link to the article). Maintenance Prednisone
Prednisone 50 mg po qod Berenson, JR et al. Maintenance therapy with alternate-day prednisone improves survival in multiple myeloma patients. Blood 2002; 99:3163 (link to the article). Bortezomib
Bortezomib (Velcade) 1.3 mg/m2 iv d1, 4, 8 and 11
Q3w Richardson PG et al. Extended follow-up of a phase 3 trial in relapsed multiple myeloma: final time-to-event results of the APEX trial. Blood 2007; 110:3557 (link to the article). Richardson, PG et al. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. N Engl J Med 2005; 352:2487 (link to the article). Richardson, PG et al. A phase 2 study of bortezomib in relapsed, refractory myeloma. N Engl J Med 2003; 348:2609 (link to the article).
Bortezomib + Pegylated liposomal doxorubicin
Bortezomib (Velcade) 1.3 mg/m2 iv bolus d1, 4, 8 and 11
Pegylated liposomal doxorubicin (Doxil) 30 mg/m2 iv over 1 h d4
Q3w until progression
Approved by FDA on 5/17/07 (link to FDA file). Orlowski RZ et al. Randomized phase III study of pegylated liposomal doxorubicin plus bortezomib compared with bortezomib alone in relapsed or refractory multiple myeloma: combination therapy improves time to progression. J Clin Oncol 2007; 25:3892 (link to the article). PAD
Bortezomib (Velcade) 1.3 mg/m2 iv bolus d1, 4, 8, 11
Dexamethasone (Decadron) 40 mg po d1-4, 8-11, 15-18 of cycle 1, d1-4 of cycles 2-4
Doxorubicin (Adriamycin) 4.5-9 mg/m2 iv qd d1-4
Q3w x 4 cycles Oakervee HE et al. PAD combination therapy (PS-341/bortezomib, doxorubicin and dexamethasone) for previously untreated patients with multiple myeloma. Br J Haematol 2005; 129:755 (link to the article). VMP
Bortezomib (Velcade) 1.3 mg/m2 iv bolus d1, 4, 8, 11, 22, 25, 29, 32 q6w x 4 cycles, then d1, 8, 22, 29 q6w x 5 cycles
Melphalan (Alkeran) 9 mg/m2 po qd d1-4 q6w x 9 cycles
Prednisone 60 mg/m2 po qd d1-4 q6w x 9 cycles Approved by FDA on 6/20/08 (link to FDA file) San Miguel JF et al. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. NEJM 2008; 359:906 (link to the article).
VMPT
Bortezomib (Velcade) 1-1.3 mg/m2 iv bolus d1, 4, 15, 22
Melphalan (Alkeran) 6 mg/m2 po qd d1-5
Prednisone 60 mg/m2 po qd d1-5
Thalidomide ((Thalomid) 50 mg po qd
Q35days x 6 cycles Palnmbo A et al. Bortezomib, melphalan, prednisone, and thalidomide for relapsed multiple myeloma. Blood 2007; 109:2767 (link to the article). Maintenance thalidomide after ASCT
Regimen 1
Thalidomide (Thalomid) 100 mg po qd starting 3 months after ASCT for 6 months Abdelkefi A et al. Single autologous stem-cell transplantation followed by maintenance therapy with thalidomide is superior to double autologous transplantation in multiple myeloma: results of a multicenter randomized clinical trial. Blood 2008; 111:1805 (link to the article). Regimen 2
Thalidomide ((Thalomid) 400-50 mg po qd
Pamidronate (Aredia) 90 mg iv q4w
Attal M et al. Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood 2006; 108:3289 (link to the article).
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