Table 5.
Suggested Dose Modifications and Considerations in Treatment Selection in Older Adults With MM
| Agent | Dosing Adjustments |
Other Considerations | ||
|---|---|---|---|---|
| Standard Dose | Reduced Dose | Further Reduction | ||
| Bortezomib | 1.3 mg/m2 twice per week on days 1, 4, 8, and 15 every 4 weeks | 1.3 mg/m2 once per week | 1.0 mg/m2 once per week | Strongly consider subcutaneous administration Consider whether patient has pre-existing renal insufficiency Consider using if patient has prior history of venous thromboembolism Consider whether adherence to an oral regimen is problematic |
| Lenalidomide (in Rd regimen) | 25 mg per day on days 1-21 every 28 days | 15 mg per day on days 1-21 every 28 days | 10 mg per day on days 1-21 every 28 days | Consider whether patient has pre-existing neuropathy Consider whether patient prefers an orally administered regimen |
| Thalidomide | 100 mg per day | 50 mg per day | 50 mg every other day | Consider whether patient prefers an orally administered regimen |
| Melphalan | 0.25 mg/kg or 9 mg/m2 on days 1-4 every 4-6 weeks | 0.18 mg/kg or 7.5 mg/m2 on days 1-4 every 4-6 weeks | 0.13 mg/kg or 5 mg/m2 on days 1-4 every 4-6 weeks | Avoid as initial therapy in older adults who are eligible for ASCT |
| Cyclophosphamide | 100 mg per day on days 1-21 every 28 days or 300 mg/m2 on days 1, 8, and 15 every 28 days | 50 mg per day on days 1-21 every 28 days or 150 mg/m2 on days 1, 8, and 15 every 28 days | 50 mg every other day on days 1-21 every 28 days or 75 mg/m2 on days 1, 8, and 15 every 28 days | May be given intravenously if oral administration is not tolerated or adherence to oral medications is problematic |
| Dexamethasone | 40 mg on day 1 once per week or consider 20 mg per day on days 1 and 2 each week | 20 mg on day 1 once per week | 10 mg on day 1 once per week | |
| Prednisone | 60 mg/m2 on days 1-4 or 50 mg every other day | 30 mg/m2 on days 1-4 or 25 mg every other day | 15 mg/m2 on days 1-4 or 12.5 mg every other day | |
NOTE. Doses listed reflect suggested dose modifications for agents in corticosteroid-incorporating doublets. Starting doses in combination regimens may vary. Modified from Palumbo et al73 and Wildes et al.74
Abbreviations: ASCT, autologous stem-cell transplantation; MM, multiple myeloma; Rd, lenalidomide and low-dose dexamethasone.