8
Treatment
Figure 1. Algorithm On Management of Patients with
Multiple Myeloma
Chronologic age
and renal function
should not be the
sole criteria used to
determine eligibility
for SCT
3-4 cycles of induction
therapy including an
immunomodulatory
drug, proteasome
inhibitor and steroids
Patient diagnosed with multiple myeloma
Whole-body low dose
CT scan for baseline
and routine bone
surveillance. FDG-PET/
CT and/or MRI may be
used as alternatives at
baseline
Assess for
transplant
eligibility at
transplant center
Transplant eligible Transplant ineligible
A novel agent
(immunomodulatory
drug or proteasome
inhibitor) and a
steroid if possible
7,8
bortezomib–
lenalidomide–
dexamethasone
OR
daratumumab+
bortezomib+
melphelan+
prednisone
Delayed initial SCT
may be considered
in select patients
High-dose
melphalan
Allogeneic
transplant may be
considered in select
high risk patients or
in the context of a
clinical trial
SCT
1,2,3,4
Lenalidomide
maintenance therapy
for standard risk
patients starting at
approimately day 90-
110 at 10-15 mg daily
until progression
6
Salvage or
delayed
SCT may
be used as
consolidation
at first relapse
for those not
choosing to
proceed to
transplant
initially
Triplet therapy
(proteasome
inhibitors,
immunomodulatory
drugs or monoclonal
antibodies)
9
Consolidation
therapy may be
considered in the
context of a clinical
trial
5
Relapsed
disease
