What is your preferred approach to a patient with myeloma who has refractory disease to Dara-VRd in the frontline setting?

Topics: Hematologic Malignancies • Medical Oncology • Myeloma • NCI-CCC Tumor Board Question • University of Chicago • NCI-CCC Myeloma Tumor Board Question • Multiple Myeloma

Answer from: Medical Oncologist at Community Practice

Unless the patient is not actually receiving some or all of the Dara-RVd (it happens), this is bad and is yet another occurrence that defines high risk disease. Most patients with this type of high risk disease don't usually have disease stability for autologous transplant, or even if they are stabl...

Comments

Medical Oncologist at University of Chicago
It’s a devastating situation! If cytopenias...

Medical Oncologist at Winship Cancer Institute of Emory University
The addition of cyclophosphamide in myeloma is gen...

Answer from: Medical Oncologist at Academic Institution

Agreed with @Craig C. Hofmeister's and @Ben Derman's excellent comments. I'd favor KPd as my general option here. And I agree wholeheartedly re: oral Cytoxan not being so useful and hyperCVAD/DCEP being very intense. As a middle ground for alkylators, I might suggest a benda-based regimen in ce...

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