Table 6.
Major Treatment Regimens in Multiple Myeloma
| Regimen | Usual Dosing Schedule* |
|---|---|
| Doublets | |
| Lenalidomide-Dexamethasone (Rd)53 | Lenalidomide 25 mg oral days 1–21 every 28 days Dexamethasone 40 mg oral days 1, 8, 15, 22 every 28 days Repeated every 4 weeks |
| Pomalidomide-Dexamethasone (Pom/Dex)104 | Pomalidomide 4 mg days 1–21 Dexamethasone 40 mg orally on days on days 1, 8, 15, 22 Repeated every 4 weeks |
| Triplets | |
| Bortezomib-Thalidomide- Dexamethasone (VTD)**36 |
Bortezomib 1.3 mg/m2 intravenous days 1, 8, 15, 22 Thalidomide 100–200 mg oral days 1–21 Dexamethasone 20 mg on day of and day after bortezomib (or 40 mg days 1, 8, 15, 22) Repeated every 4 weeks × 4 cycles as pre-transplant induction therapy |
| Bortezomib- Cyclophosphamide- Dexamethasone** (VCD or CyBorD)60,62 |
Cyclophosphamide 300 mg/m2 orally on days 1, 8, 15 and 22 Bortezomib 1.3 mg/m2 intravenously on days 1, 8, 15, 22 Dexamethasone 40 mg orally on days on days 1, 8, 15, 22 Repeated every 4 weeks† |
| Bortezomib-Lenalidomide- Dexamethasone (VRD)**60,61 |
Bortezomib 1.3 mg/m2 intravenous days 1, 8, 15 Lenalidomide 25 mg oral days 1–14 Dexamethasone 20 mg on day of and day after bortezomib (or 40 mg days 1, 8, 15, 22) Repeated every 3 weeks‡ |
| Carfilzomib- Cyclophosphamide- Dexamethasone (CCyD) ‡‡ 105 |
Carfilzomib 20 mg/m2 (Cycle 1) and 36 mg/ m2 (subsequent cycles) intravenously on days 1, 2, 8, 9, 15, 16 Cyclophosphamide 300 mg/m2 orally on days 1, 8, 15 Dexamethasone 40 mg orally on days on days 1, 8, 15 Repeated every 4 weeks† |
| Carfilzomib-Lenalidomide- Dexamethasone (KRD)106 |
Carfilzomib 27 mg/ m2 intravenously on days 1, 2, 8, 9, 15, 16 (Note: Cycle 1, day 1 and 2 carfilzomib dose is 20 mg/m2) Lenalidomide 25 mg oral days 1–21 Dexamethasone 20 mg on day of and day after bortezomib (or 40 mg days 1, 8, 15, 22) Repeated every 4 weeks |
| Carfilzomib-Pomalidomide- Dexamethasone 107 |
Carfilzomib 27 mg/ m2 intravenously on days 1, 2, 8, 9, 15, 16 (Note: Cycle 1, day 1 and 2 carfilzomib dose is 20 mg/m2) Pomalidomide 4 mg oral days 1–21 Dexamethasone 40 mg days 1, 8, 15, 22 Repeated every 4 weeks |
All doses need to be adjusted for performance status, renal function, blood counts, and other toxicities
Doses of dexamethasone and/or bortezomib reduced based on subsequent data showing lower toxicity and similar efficacy with reduced doses.
The day 22 dose of all 3 drugs is omitted if counts are low, or after initial response to improve tolerability, or when the regimen is used as maintenance therapy; When used as maintenance therapy for high risk patients, further delays can be instituted between cycles.
Omit day 15 dose if counts are low or when the regimen is used as maintenance therapy; When used as maintenance therapy for high risk patients, lenalidomide dose may be decreased to 10–15 mg per day, and delays can be instituted between cycles as done in total therapy protocols.67,68
Dosing based on trial in newly diagnosed patients; in relapsed patients cycle 2 Carfilzomib dose is 27 mg/m2 consistent with approval summary Modified from Rajkumar SV. Multiple myeloma: 2014 update on diagnosis, risk-stratification, and management. Am J Hematol 2014;89:998–1009.