A 62-year-old man presents with fatigue, bone pain, hypercalcemia, and a serum protein electrophoresis showing a monoclonal (M) protein spike of 4.2 g/dL (IgG lambda). Bone marrow biopsy shows 35% plasma cells. Serum free light chain ratio is abnormal. CRAB criteria are met. What is the current first-line triplet regimen for transplant-eligible newly diagnosed multiple myeloma?

• A MP (melphalan + prednisolone)
• B Thalidomide + dexamethasone (TD)
• C Daratumumab monotherapy
• D VRd (bortezomib + lenalidomide + dexamethasone) ✓

Explanation

VRd (bortezomib/lenalidomide/dexamethasone) is the preferred induction regimen for transplant-eligible NDMM based on SWOG S0777 and IFM trials demonstrating superior PFS and OS compared to doublets. The current IMWG standard is 4–6 cycles of VRd followed by high-dose melphalan and autologous SCT, then lenalidomide maintenance. Daratumumab-VRd (D-VRd) is emerging as a new standard per the GRIFFIN/PERSEUS trials. MP is for elderly non-transplant candidates. TD alone is inferior and largely historical.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.