A 65-year-old man with multiple myeloma has serum creatinine 2.1 mg/dL, calcium 11.4 mg/dL, and bone marrow plasmacytosis of 25%. His serum free light chain ratio is markedly abnormal. He is deemed ineligible for autologous stem cell transplant due to cardiac comorbidities. Which regimen is the current standard of care for transplant-ineligible NDMM based on MAIA trial data?

• A Melphalan-prednisone-thalidomide (MPT)
• B Daratumumab-lenalidomide-dexamethasone (Dara-Rd) continuous therapy ✓
• C Bortezomib-melphalan-prednisone (VMP) for 9 cycles
• D Lenalidomide-dexamethasone (Rd) alone

Explanation

The MAIA trial demonstrated that the addition of daratumumab (anti-CD38 monoclonal antibody) to lenalidomide-dexamethasone (Dara-Rd) significantly improved progression-free survival and overall survival in transplant-ineligible newly diagnosed multiple myeloma. Dara-Rd is now the preferred standard of care for this population. Lenalidomide-dexamethasone alone (Rd) remains an option but is inferior to the Dara-Rd triplet.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.