5
➤ Physicians/patients should balance the potential improvement in
response and disease control with a possible increase in toxicity.
Initial dosing should be individualized based on patient age,
renal function, comorbidities, functional status and frailty status.
Subsequent dosing may be tailored based on initial response and
tolerability. (Moderate Recommendation; EB-I-B)
➤ Continuous therapy should be offered over fixed duration therapy
when initiating an immunomodulatory drug or proteasome inhibitor-
based regimen. (Strong Recommendation; EB-H-B)
➤ The goal of initial therapy for transplant ineligible patients should be
achievement of the best quality and depth of remission. (Moderate
Recommendation; EB-I-B)
➤ Depth of response for all patients should be assessed by IMWG
criteria (Table 5) regardless of transplant eligibility. (Moderate
Recommendation; EB-H-B)
➤ There is insufficient evidence to support change in type and length
of therapy based on depth of response as measured by conventional
IMWG approaches or MRD. (Moderate Recommendation; IC-L-H)
➤ Upon initiation of therapy, one should define patient specific goals of
therapy. Quality of life assessment (including symptom management
and tolerability of treatment) should be assessed at each visit to
determine if the goals of therapy are being maintained/met and this
should influence the intensity and duration of treatment. Redefining
the goals prospectively, based on response, symptoms and quality of
life is recommended. (Moderate Recommendation; IC-L-B)
➤ It is recommended that patients be monitored closely with
consideration of dose modifications based on levels of toxicity,
neutropenia, fever/infection, tolerability of side effects, performance
status, liver and kidney function and in keeping with the goals of
treatment. (Moderate Recommendation; IC-L-B)
