Table 2. Recommended reductions in starting doses for elderly patients newly diagnosed with multiple myeloma5.
| Dose level 0 | Dose level –1 | Dose level –2 | |
|---|---|---|---|
| Dexamethasone | 40 mg weekly | 20 mg weekly | 10 mg further reduction if needed |
| Prednisone | 30 mg on alternate days | ||
| Melphalan (days 1–4) | 0.25 mg/kg | 0.18 mg/kg | 0.13 mg/kg |
| Cyclophosphamide | 50 mg/day | Reduction to alternating day dosing | |
| Thalidomide | 200 mg/day | 100 mg/day | 50 mg/day |
| Lenalidomide (days 1–21 in combination with dexamethasone) | 25 mg/day | 15 mg/day | 10 mg/day |
| Lenalidomide (days 1–21 in combination with melphalan and prednisone) | 10 mg/day | 5 mg/day | 5 mg on alternate days |
| Bortezomib | 1.3 mg/m2 twice weekly | 1.3 mg/m2 weekly | 1.0 mg/m2 weekly |
Table adapted and expanded from Table 4, Palumbo and Gay, 2009. Republished with permission of American Society of Hematology (ASH) from ‘How to treat elderly patients with multiple myeloma: combination of therapy or sequencing,' Palumbo A, Gay F, Hematology Am Soc Hematol Educ Program 2009:566–577; permission conveyed through Copyright Clearance Center, Inc.