A 72-year-old man is diagnosed with multiple myeloma with 60% plasma cells in bone marrow, serum calcium 11.8 mg/dL, creatinine 1.9 mg/dL, and haemoglobin 8.2 g/dL. FISH shows del(17p) and t(4;14). He is not a transplant candidate. According to IMWG 2023 guidance, the preferred induction regimen is:

• A Melphalan + prednisone (MP)
• B Thalidomide + dexamethasone
• C Bortezomib + dexamethasone (VD) doublet only
• D Daratumumab + bortezomib + lenalidomide + dexamethasone (Dara-VRd) ✓

Explanation

High-risk cytogenetics [del(17p), t(4;14), t(14;16)] in newly diagnosed MM require proteasome inhibitor–based therapy; the IMWG and updated guidelines now favour quadruplet regimens with CD38-directed antibodies. The MAIA trial showed daratumumab + lenalidomide + dexamethasone superiority; for transplant-ineligible high-risk patients, Dara-VRd is the current preferred option per IMWG 2023 recommendations. Melphalan-prednisone is outdated. Thalidomide-dexamethasone doublet is inferior. VD alone is insufficient for high-risk disease.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.