Table 1.
Clinical course and transfusion requirements in response to various regimens.
| Month | M Spike (mg/dL) | RBC transfusion | Platelet transfusion | Regimen | Reason for change in regimen |
|---|---|---|---|---|---|
| −6 | 1.99 | 0 | 0 | LD | |
| −5 | 3.15 | 0 | 0 | LD | |
| −4 | 2.28 | 0 | 0 | LDC | Disease progression on Ld |
| −3 | 3.47 | 4 | 4 | Melphalan | Intolerability to LDC |
| −2 | NM | 12 | 12 | None | |
| −1 | 4.86 | 6 | 6 | VDD | Disease progression |
| 0 | 5.35 | 6 | 6 | VDDT/LDT | Tadalafil initiated by patient |
| 1 | 5.07 | 8 | 8 | LDT | Disease progression on VDD |
| 2 | 4.4 | 6 | 6 | LDT | |
| 3 | NM | 6 | 6 | LDCT | Synergy of Clarithromycin & Lenalidomide |
| 4 | 3.6 | 4 | 4 | LDCT | |
| 5 | 1.88 | 2 | 0 | LDCT | |
| 6 | 1.24 | 0 | 0 | LDCT | |
| 7 | 0.81 | 2 | 0 | LDCT | |
| 8 | 0.65 | 0 | 0 | LDCT | |
| 9 | 0.69 | 0 | 0 | LDCT | |
| 10 | 0.62 | 0 | 0 | LDCT | |
| 11 | 0.58 | 0 | 0 | LDCT | |
| 12 | 0.78 | 0 | 0 | LDCT | |
| 13 | 0.87 | 0 | 0 | LDCT | |
| 14 | 0.72 | 0 | 0 | LDCT | |
| 15 | 0.93 | 0 | 0 | LDCT | |
| 16 | 1.16 | 2 | 0 | LDCT |
LD: Lenalidomide and dexamethasone; LDC: Lenalidomide, dexamethasone and clarithromycin; VDD: Bortezomib, liposomal doxorubicin and dexamethasone; VDDT: Bortezomib, liposomal doxorubicin, dexamethasone and tadalafil; LDT: Lenalidomide, dexamethasone and tadalafil; LDCT: Lenalidomide, dexamethasone, clarithromycin and tadalafil; NM: not measured. RBC transfusion measured as units of red cells transfused per month. Platelet transfusion measured as units of single donor platelets transfused per month.