A 58-year-old woman is diagnosed with multiple myeloma (MM): serum M-protein IgG kappa 4.2 g/dL, plasma cells 35% on bone marrow biopsy, multiple lytic lesions. She is transplant-eligible. According to current guidelines, what is the preferred induction regimen?

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

Explanation

For transplant-eligible newly diagnosed MM, the SWOG S0777 and ENDURANCE trials established VRd (bortezomib + lenalidomide + dexamethasone) as the standard-of-care induction regimen, achieving high rates of very good partial response (VGPR) and complete response (CR) prior to autologous SCT. The GRIFFIN trial added daratumumab (Dara-VRd) with superior MRD negativity rates; Dara-VRd is now an emerging preferred regimen. MPT is for transplant-ineligible patients. CyBorD is an acceptable alternative but inferior in depth of response to VRd.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.