A 55-year-old man with newly diagnosed multiple myeloma has renal impairment (creatinine 2.4 mg/dL), bone pain, and calcium 11.8 mg/dL. Bone marrow biopsy shows 40% plasma cells. FISH reveals t(4;14) translocation. He is eligible for autologous stem cell transplantation. What is the standard induction regimen?

• A Melphalan-prednisone-thalidomide (MPT)
• B Bortezomib-lenalidomide-dexamethasone (VRd) ✓
• C CHOP chemotherapy
• D Cyclophosphamide-thalidomide-dexamethasone (CTD)

Explanation

For transplant-eligible patients with newly diagnosed multiple myeloma, bortezomib-lenalidomide-dexamethasone (VRd) is the current standard induction regimen based on the SWOG S0777 trial, which showed superior PFS and OS versus Rd alone. The t(4;14) translocation confers high-risk cytogenetics, and bortezomib-containing regimens partially overcome this adverse prognosis. Melphalan-containing regimens impair stem cell collection and are avoided pre-transplant. CHOP is for lymphomas.

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

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Written and medically reviewed by the StethoPrep medical team.