Multiple myeloma

Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.

Induction therapy

Dexamethasone (Decadron)

Regimen

• Dexamethasone (Decadron) 40 mg PO on days 1-4, 9-12, 17-20 for cycles 1-2; 40 mg PO on days 1-4 of cycles 3-12

6-week cycles x 12 cycles

References

1. Facon T, Mary JY, Pégourie B, Attal M, Renaud M, Sadoun A, Voillat L, Dorvaux V, Hulin C, Lepeu G, Harousseau JL, Eschard JP, Ferrant A, Blanc M, Maloisel F, Orfeuvre H, Rossi JF, Azaïs I, Monconduit M, Collet P, Anglaret B, Yakoub-Agha I, Wetterwald M, Eghbali H, Vekemans MC, Maisonneuve H, Troncy J, Grosbois B, Doyen C, Thyss A, Jaubert J, Casassus P, Thielemans B, Bataille R; Intergroupe Francophone du Myélome (IFM) group. Dexamethasone-based regimens versus melphalan-prednisone for elderly multiple myeloma patients ineligible for high-dose therapy. Blood. 2006 Feb 15;107(4):1292-8. Epub 2005 Sep 20. link to original paper contains protocol PubMed

Melphalan (Alkeran) & Prednisone (Sterapred)

Regimen

• Melphalan (Alkeran) 0.15 mg/kg PO on days 1-7
• Prednisone (Sterapred) 20 mg PO TID on days 1-7

6-week cycles

Alternate regimen #1 (San Miguel, et al. 2008)

• Melphalan (Alkeran) 0.25 mg/kg PO on days 1-4
• Prednisone (Sterapred) 2 mg/kg PO on days 1-4

6-week cycles x 12 cycles

Alternate regimen #2 (Facon, et al. 2006)

• Melphalan (Alkeran) 9 mg/m2 PO on days 1-4
• Prednisone (Sterapred) 60 mg/m2 PO on days 1-4

6-week cycles x 9 cycles

References

1. Kyle RA. Monoclonal gammopathy and multiple myeloma in the elderly. Baillieres Clin Haematol. 1987 Jun;1(2):533-57. PubMed
2. Facon T, Mary JY, Pégourie B, Attal M, Renaud M, Sadoun A, Voillat L, Dorvaux V, Hulin C, Lepeu G, Harousseau JL, Eschard JP, Ferrant A, Blanc M, Maloisel F, Orfeuvre H, Rossi JF, Azaïs I, Monconduit M, Collet P, Anglaret B, Yakoub-Agha I, Wetterwald M, Eghbali H, Vekemans MC, Maisonneuve H, Troncy J, Grosbois B, Doyen C, Thyss A, Jaubert J, Casassus P, Thielemans B, Bataille R; Intergroupe Francophone du Myélome (IFM) group. Dexamethasone-based regimens versus melphalan-prednisone for elderly multiple myeloma patients ineligible for high-dose therapy. Blood. 2006 Feb 15;107(4):1292-8. Epub 2005 Sep 20. link to original paper contains protocol PubMed
3. San Miguel JF, Schlag R, Khuageva NK, Dimopoulos MA, Shpilberg O, Kropff M, Spicka I, Petrucci MT, Palumbo A, Samoilova OS, Dmoszynska A, Abdulkadyrov KM, Schots R, Jiang B, Mateos MV, Anderson KC, Esseltine DL, Liu K, Cakana A, van de Velde H, Richardson PG; VISTA Trial Investigators. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med. 2008 Aug 28;359(9):906-17. link to original article contains protocol PubMed

RD

RD: Revlimid, Dexamethasone

Regimen

• Lenalidomide (Revlimid) 25 mg PO days 1-21
• Dexamethasone (Decadron) 40 mg PO days 1, 8, 15, 22

28-day cycles

Alternate regimen #1 (Rajkumar, et al. 2010)

• Lenalidomide (Revlimid) 25 mg PO days 1-21
• Dexamethasone (Decadron) 40 mg PO days 1-4, 9-12, 17-20

28-day cycles

Supportive medications:

• EITHER pamidronate 90 mg IV over 2-4 hours every 28 days
• OR Zoledronic acid (Zometa) 4 mg IV over 15 minutes every 28 days
• "Thromboprophylaxis" aspirin (80 mg or 325 mg per physician discretion) once daily as thrombosis prophylaxis.

Alternate regimen #2 (Rajkumar, et al. 2005; Dimopoulos, et al. 2007; Weber, et al. 2007)

• Lenalidomide (Revlimid) 25 mg PO days 1-21
• Dexamethasone (Decadron) 40 mg PO days 1-4, 9-12, 17-20 of cycles 1-4; 40 mg PO days 1-4 of cycle 5 and thereafter

28-day cycles

Supportive medications (only listed in Rajkumar, et al. 2005):

• Aspirin 80 mg or 325 mg depending on physician choice PO daily for thromboprophylaxis

References

1. Rajkumar SV, Hayman SR, Lacy MQ, Dispenzieri A, Geyer SM, Kabat B, Zeldenrust SR, Kumar S, Greipp PR, Fonseca R, Lust JA, Russell SJ, Kyle RA, Witzig TE, Gertz MA. Combination therapy with lenalidomide plus dexamethasone (Rev/Dex) for newly diagnosed myeloma. Blood. 2005 Dec 15;106(13):4050-3. Epub 2005 Aug 23. link to original article contains protocol PubMed
2. Dimopoulos M, Spencer A, Attal M, Prince HM, Harousseau JL, Dmoszynska A, San Miguel J, Hellmann A, Facon T, Foà R, Corso A, Masliak Z, Olesnyckyj M, Yu Z, Patin J, Zeldis JB, Knight RD; Multiple Myeloma (010) Study Investigators. Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N Engl J Med. 2007 Nov 22;357(21):2123-32. link to original article contains protocol PubMed
3. Weber DM, Chen C, Niesvizky R, Wang M, Belch A, Stadtmauer EA, Siegel D, Borrello I, Rajkumar SV, Chanan-Khan AA, Lonial S, Yu Z, Patin J, Olesnyckyj M, Zeldis JB, Knight RD; Multiple Myeloma (009) Study Investigators. Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. N Engl J Med. 2007 Nov 22;357(21):2133-42. link to original article contains protocol PubMed
4. Rajkumar SV, Jacobus S, Callander NS, Fonseca R, Vesole DH, Williams ME, Abonour R, Siegel DS, Katz M, Greipp PR; Eastern Cooperative Oncology Group. Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol. 2010 Jan;11(1):29-37. Epub 2009 Oct 21. link to original article contains protocol PubMed

TD

TD: Thalidomide, Dexamethasone

Regimen

• Thalidomide (Thalomid) 50 mg PO days 1-14 of cycle 1; 100 mg PO days 15-28 of cycle 1; 200 mg PO days 1-28 of cycle 2 and thereafter
• Dexamethasone (Decadron) 40 mg PO days 1-4, 9-12, 17-20 during cycles 1-4; 40 mg PO days 1-4 of cycle 5 and thereafter

28-day cycles

Alternate regimen (Rajkumar, et al. 2002, Rajkumar, et al. 2006)

• Thalidomide (Thalomid) 200 mg PO days 1-28
• Dexamethasone (Decadron) 40 mg PO days 1-4, 9-12, 17-20 on odd-numbered cycles; 40 mg PO days 1-4 of even-numbered cycles

28-day cycles

References

1. Weber D, Rankin K, Gavino M, Delasalle K, Alexanian R. Thalidomide alone or with dexamethasone for previously untreated multiple myeloma. J Clin Oncol. 2003 Jan 1;21(1):16-9. link to original article PubMed
2. Rajkumar SV, Hayman S, Gertz MA, Dispenzieri A, Lacy MQ, Greipp PR, Geyer S, Iturria N, Fonseca R, Lust JA, Kyle RA, Witzig TE. Combination therapy with thalidomide plus dexamethasone for newly diagnosed myeloma. J Clin Oncol. 2002 Nov 1;20(21):4319-23. link to original article PubMed
3. Rajkumar SV, Blood E, Vesole D, Fonseca R, Greipp PR; Eastern Cooperative Oncology Group. 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 Jan 20;24(3):431-6. Epub 2005 Dec 19. link to original article contains protocol PubMed
4. Rajkumar SV, Rosiñol L, Hussein M, Catalano J, Jedrzejczak W, Lucy L, Olesnyckyj M, Yu Z, Knight R, Zeldis JB, Bladé J. 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 May 1;26(13):2171-7. Epub 2008 Mar 24. link to original article contains protocol PubMed

VAD

VAD: Vincristine, Adriamycin, Dexamethasone

Regimen

• Vincristine (Oncovin) 0.4 mg IV over 30 minutes on days 1-4
• Doxorubicin (Adriamycin) 9 mg/m2 IV over 30 minutes on days 1-4
• Dexamethasone (Decadron) 40 mg PO on days 1-4, 9-12, 17-20 of odd-numbered cycles only

4-week cycles

Supportive medications (not listed consistently in references):

• Fluconazole (Diflucan) 200 mg PO daily
• Trimethoprim/Sulfamethoxazole 960 mg (paper did not specify which component was 960 mg) PO BID for "prophylaxis"

References

1. Segeren CM, Sonneveld P, van der Holt B, Baars JW, Biesma DH, Cornellissen JJ, Croockewit AJ, Dekker AW, Fibbe WE, Löwenberg B, van Marwijk Kooy M, van Oers MH, Richel DJ, Schouten HC, Vellenga E, Verhoef GE, Wijermans PW, Wittebol S, Lokhorst HM. Vincristine, doxorubicin and dexamethasone (VAD) administered as rapid intravenous infusion for first-line treatment in untreated multiple myeloma. Br J Haematol. 1999 Apr;105(1):127-30. link to original article contains protocol PubMed
2. Dimopoulos MA, Pouli A, Zervas K, Grigoraki V, Symeonidis A, Repoussis P, Mitsouli C, Papanastasiou C, Margaritis D, Tokmaktsis A, Katodritou I, Kokkini G, Terpos E, Vyniou N, Tzilianos M, Chatzivassili A, Kyrtsonis MC, Panayiotidis P, Maniatis A; Greek Myeloma Study Group. Prospective randomized comparison of vincristine, doxorubicin and dexamethasone (VAD) administered as intravenous bolus injection and VAD with liposomal doxorubicin as first-line treatment in multiple myeloma. Ann Oncol. 2003 Jul;14(7):1039-44. link to original article contains protocol PubMed

DVD

DVD: Doxil, Vincristine, Dexamethasone

Regimen

• Doxorubicin liposomal (Doxil) 40 mg/m2 IV day 1
• Vincristine (Oncovin) 2 mg IV day 1
• Dexamethasone (Decadron) 40 mg PO/IV days 1-4

4-week cycles x 6-8 cycles

Supportive medications:

• Vitamin B6 200 mg PO daily to help reduce risk of palmar–plantar erythrodysesthesia (PPE)

References

1. Hussein MA, Wood L, Hsi E, Srkalovic G, Karam M, Elson P, Bukowski RM. A Phase II trial of pegylated liposomal doxorubicin, vincristine, and reduced-dose dexamethasone combination therapy in newly diagnosed multiple myeloma patients. Cancer. 2002 Nov 15;95(10):2160-8. link to original article contains protocol PubMed