A 72-year-old man has IgG kappa monoclonal protein of 4.8 g/dL, serum free light chain ratio 145, bone marrow plasma cells 18%, multiple lytic bone lesions, and serum calcium 11.6 mg/dL. He is considered transplant-ineligible. Which induction regimen is preferred per IMWG guidelines?

• A Melphalan and prednisolone (MP)
• B Cyclophosphamide, thalidomide, and dexamethasone (CTD)
• C Bortezomib, lenalidomide, and dexamethasone (VRd) ✓
• D Daratumumab monotherapy

Explanation

VRd (bortezomib + lenalidomide + dexamethasone) is the preferred induction regimen for newly diagnosed multiple myeloma in transplant-ineligible patients based on the SWOG S0777 trial, demonstrating superior PFS and OS compared to Rd alone. Daratumumab-VRd is emerging but VRd remains the standard referenced in IMWG guidelines. Melphalan-prednisolone is now rarely used; CTD is a less commonly preferred alternative.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.