What induction regimen would you choose for a patient with newly diagnosed multiple myeloma with incidental amyloidosis noted on bone marrow biopsy, but with no end-organ damage as a result of amyloid deposition?

Congo red on a bone marrow is a challenge. The expertise with Congo red is low at most sites in the U.S., hence the sensitivity of the stain in the marrow is 50%. It's worth testing a patient with any Congo red positivity with appropriate cardiac biomarkers, transthoracic ECHOcardiogram, and 24hr ur...

Super helpful answers by @Dr. First Last and @Dr. First Last. As always, confirming the Congo red positivity by LC/MS is prudent. In a study pertinent to this situation, Chakraborty et al., PMID 27328653 looked at 117 patients with an incidental congo red positivity (fat or marrow) without any amylo...

This is a great question and a great discussion. I think we should be cautious in the way we interpret IFM2013-04 (VTd vs VCd) as the endpoint was response rate at the end of 4 cycles. That's not really a robust comparison.

However, I too prefer IMiD-based induction over cyclophosphamide-based induc...

I agree wholeheartedly with a Revlimid-based therapy for myeloma with clinically insignificant amyloid.

To stick up for cyclophosphamide after that little gut punch (I think it's especially useful in RRMM that hasn't previously seen alkylating agents) - once upon a time there was a randomized ph2 ca...