Table 2:
Dose modification of drugs used for the treatment of multiple myeloma according to Creatinine Clearance (CrCl)
| Drug | > 60 ml/min | 30-59 ml/min | 15-29 ml/min | <15 ml/min | On dialysis |
|---|---|---|---|---|---|
| Melphalan PO, mg/kg/d | 0.15-0.25 | 0.11-0.19 | 0.11-0.19 | 0.0175-0.125 | 0.0175-0.125 |
| Cyclophosphamide | 300 mg/m2 | No dose adjustment required | |||
| Doxorubicin | 30 mg/m2 | No dose adjustment required | |||
| Carmustine | 150-200 mg/m2 (single dose or divided in 2 days) | No dose adjustment required | Discontinue at CrCl < 10 | ||
| Plerixafor | 0.24 mg/kg/d | ≤50 CrCl, 0.16 mg/kg/d | |||
| Dexamethasone | 20-40 mg | No dose adjustment required | |||
| Prednisone | According to regimen | No dose adjustment required | |||
| Thalidomide | 50-200 mg/d | No dose adjustment required | |||
| Lenalidomide | 25 mg/d | 10 mg/d | 15 mg/48hr | 5 mg/d | 5 mg/d, post-dialysis |
| Pomalidomide | 4 mg/d | No dose adjustment required | NA | 3 mg/d post-dialysis | |
| Bortezomib | 1.3 mg/m2 | No dose adjustment required | |||
| Carfilzomib | According to regimen (20/27/56 mg/m2) | No dose adjustment required | |||
| Ixazomib | 4 mg/d | No dose adjustment required | 3 mg/d | 3 mg | 3 mg, pre or post dialysis |
| Panobinostat | 20 mg/d | No dose adjustment required | Not studied | ||
| Daratumumab | 16 mg/kg | No dose adjustment required | |||
| Elotuzumab | 10 mg/kg | No dose adjustment required | |||
| Pamidronate | 90 mg monthly | No dose adjustment required | Not recommended | ||
| Zoledronic acid (monthly) | 4 mg | 3 - 3.5 mg CrCl 50-60 ml/min: 3.5mg, 40-49: 3.3 mg, 30-39: 3 mg. | Not recommended | ||
| Denosumab | 120 mg monthly | No dose adjustment required | |||
| Enoxaparin | 40 mg/d | No dose adjustment required | 30 mg/d | ||