9
1
Agents associated with stem cell toxicity, such as melphalan and/or prolonged
immunomodulatory drugs exposure (more than 4 cycles), should be avoided in patients
who are potential candidates for SCT.
2
Ample stem cell collection (sufficient for more than one SCT) should be considered
upfront, due to concern for limited ability for future stem cell collection aer prolonged
treatment exposure.
3
e level of minimal response required to proceed to SCT is not established for patients
receiving induction therapy — patients should be referred for SCT independent of depth
of response.
4
Tandem autologous SCT should not be routinely recommended.
5
For patient's ineligible or unwilling to consider maintenance therapy, consolidation
therapy for at least 2 cycles may be considered.
6
For patients intolerant of or unable to receive lenalidomide, bortezomib maintenance
every 2 weeks may be considered. For high-risk patients, maintenance therapy with a
proteasome inhibitor +/- lenalidomide may be considered.
7
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.
8
Depth of response for all patients should be assessed by IMWG criteria.
9
Prior therapies should be taken into consideration when selecting the treatment at first
relapse.
Figure 1. Algorithm On Management of Patients with
Multiple Myeloma — Footnotes
