Fit patients in good or well-controlled health

Source: Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®)–Health Professional Version, National Cancer Institute.

Source updated: April 25, 2025 · Captured 2026-09-09.

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Context: Treatment of Multiple Myeloma / Therapeutic Overview / Symptomatic myeloma

Patients in good or well-controlled health may receive induction chemotherapy with a four-drug (quadruplet) or three-drug (triplet) approach that includes bortezomib in the absence of a clinical trial. The most commonly used regimens include:

D-VRd: daratumumab + bortezomib + lenalidomide + dexamethasone.[11,12]

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I-VRd: isatuximab + bortezomib + lenalidomide + dexamethasone.[13,14]

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D-CVRd: daratumumab + cyclophosphamide + bortezomib + lenalidomide + dexamethasone.

VRd: bortezomib + lenalidomide + dexamethasone.[15-18]

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CyBorD: cyclophosphamide + bortezomib + dexamethasone.[19,20] This regimen is preferred in the presence of significant renal dysfunction (creatinine clearance less than 45 cc/min). If the renal function recovers rapidly, some clinicians switch to VRd.

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After 4 to 8 months of therapy, patients with disease response may undergo autologous SCT consolidation.[16,21] The previously standard autologous SCT consolidation has been questioned because a large, prospective, randomized trial failed to demonstrate an overall survival (OS) benefit.[22] Maintenance therapy is then implemented until the time of relapse.[23-25] At relapse, subsequent therapies are given sequentially by using previously successful drugs (if the interval of time since previous exposure is >1 year) or newer drugs not previously tried.

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Preserved source evidence · Not medical advice