For multiple myeloma patients with vertebral lesions requiring palliative radiation (e.g. 20-30 Gy in 10fx), do you treat concurrently with modern systemic myeloma agents such as lenalidomide and bortezomib?

We found in an institutional retrospective experience that patients with MM can safely be treated with lenalidomide, bortezomib, and cytotoxic therapy with palliative xrt.

https://www.ncbi.nlm.nih.gov/pubmed/25176474

For palliative radiation, I do not treat myeloma with concurrent chemothereapy, although I may not ask the patients to stop their chemo if they are already on it.

An additional large series was published showing no additional toxicity when XRT was added to newer biologic agents, though numerically, there does appear to be a trend towards increased acute morbidity of combined treatment:

Salgado et al., PMID 30706018.