How do you approach patients with recurrent grade 3+ neutropenia on IMiD-containing regimens (e.g., VRd or KRd) beyond dose reductions?

IMiD dosing is a challenge. Let's start with what we know:

1. The FDA approved dose of thalidomide is out of date and the OPTIMUM trial suggests 100 mg PO qHS is the "best" dose (Kropff et al., PMID 22133776) because 400 mg is far too toxic.
2. The phase 1 of Pomalidomide does not demonstrate superiority ...