A 65-year-old patient with multiple myeloma has achieved VGPR after VRd (bortezomib, lenalidomide, dexamethasone) induction. He is transplant-eligible. Serum free light chain ratio is abnormal. What is the next most appropriate step?
- A Autologous stem cell transplantation followed by lenalidomide maintenance ✓
- B Continue VRd for 8 more cycles and then observation
- C Allogeneic stem cell transplantation as preferred consolidation
- D Switch to carfilzomib-based regimen as salvage
Correct answer: A. Autologous stem cell transplantation followed by lenalidomide maintenance
Explanation
For transplant-eligible myeloma patients achieving response after induction, upfront autologous SCT (ASCT) followed by lenalidomide maintenance remains the standard of care (IFM 2009, DETERMINATION trials). Lenalidomide maintenance post-ASCT has been shown to prolong PFS and OS. Allogeneic SCT is experimental in myeloma due to high transplant-related mortality. Continuing induction without ASCT in eligible patients is inferior to ASCT. There is no indication for salvage therapy after VGPR.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.