What is your preferred approach to therapy in transplant ineligible multiple myeloma initially treated with CyBorD owing to acute renal failure, after achieving a VGPR (+IFE alone) with continued mild-moderate renal impairment?
Would you change to an alternative triplet therapy, or switch to maintenance therapy?
Are there variations in depth of response short of CR that would influence your decision above?
If further triplet therapy were chosen, but lenalidomide were contraindicated due to renal impairment, what regimens would you consider switching to?
Would ixazomib offer any additional benefit over bortezomib-containing triplets or maintenance in this setting?
1 Answer
Mednet MemberInvited Expert
Medical Oncology · Massachusetts General Hospital
Answered on · Updated on
After completion of initial treatment, our practice is to offer patients maintenance therapy with Revlimid based on the meta-analysis of Revlimid maintenance done in patients following autologous stem cell transplant. This includes patients who have not had lenalidomide upfront. Using maintenance lenalidomide in patients who have not had a transplant is an extrapolation, though there is data from Myeloma XI that shows improvement in PFS.
If the patient has high risk FISH (e.g. t(4;14), del17p, et...
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