A 65-year-old man with multiple myeloma is being considered for treatment. He has 60% plasma cells on bone marrow biopsy, serum M-protein of 4.8 g/dL, serum calcium 2.7 mmol/L, creatinine 180 µmol/L, and lytic bone lesions on skeletal survey. He is considered transplant-ineligible. The preferred induction regimen per current guidelines is:

• A Melphalan-prednisone (MP) alone
• B Bortezomib-thalidomide-dexamethasone (VTD) only
• C Cyclophosphamide-vincristine-doxorubicin-dexamethasone (CVAD)
• D Daratumumab-lenalidomide-dexamethasone (Dara-Rd) ✓

Explanation

The MAIA trial demonstrated superior progression-free and overall survival with daratumumab-lenalidomide-dexamethasone (Dara-Rd) versus lenalidomide-dexamethasone alone in newly diagnosed transplant-ineligible multiple myeloma. Dara-Rd is now considered a standard of care in this group. Melphalan-prednisone is largely obsolete. VTD is used in transplant-eligible patients.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.