Table 8.
Regimen | Usual Dosing Schedule* |
---|---|
Melphalan-Prednisone (MP) (7-day schedule)39 | Melphalan 8–10 mg oral days
1–7 Prednisone 60 mg/day oral days 1–7 Repeated every 6 weeks |
Thalidomide-Dexamethasone (TD)**40,41 | Thalidomide 200 mg oral days
1–28 Dexamethasone 40 mg oral days 1, 8, 15, 22 Repeated every 4 weeks |
Lenalidomide-Dexamethasone (Rd)42 | 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 |
Bortezomib-Dex (VD)**43 | Bortezomib 1.3 mg/m2 intravenous
days 1, 8, 15, 22 Dexamethasone 20 mg on day of and day after bortezomib (or 40 mg days 1, 8, 15, 22) Repeated every 4 weeks |
Melphalan-Prednisone-Thalidomide (MPT)44,45 | Melphalan 0.25 mg/kg oral days 1–4
(use 0.20 mg/kg/day oral days 1–4 in patients over the age of
75) Prednisone 2 mg/kg oral days 1–4 Thalidomide 100–200 mg oral days 1–28 (use 100 mg dose in patients >75) Repeated every 6 weeks |
Bortezomib-Melphalan-Prednisone (VMP)**46–48 | Bortezomib 1.3 mg/m2 intravenous
days 1, 8, 15, 22 Melphalan 9 mg/m2 oral days 1–4 Prednisone 60 mg/m2 oral days 1 to 4 Repeated every 35 days |
Bortezomib-Thalidomide-Dexamethasone (VTD)**49 | 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)50,52 | 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)**51,52 | 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‡ |
Carfilzomib53 | Carfilzomib 20 mg/m2 (Cycle 1) and
27 mg/m2 (subsequent cycles) intravenously on days 1, 2, 8,
9, 15, 16 Repeated every 4 weeks† |
Carfilzomib-Cyclophosphamide-Dexamethasone (CCyD) ‡‡54 | 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)55 | 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 |
Pomalidomide-Dexamethasone (Pom/Dex)56 | Pomalidomide 4 mg days
1–21 Dexamethasone 40 mg orally on days on days 1, 8, 15, 22 Repeated every 4 weeks |
Carfilzomib-Pomalidomide-Dexamethasone129 | 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.130,131
Dosing based on trial in newly diagnosed patients; in relapsed patients cycle 2 Carfilzomib dose is 27 mg/m2 consistent with approval summary. Adapted from Am J Hematol.2