A 70-year-old man has multiple myeloma with serum creatinine 3.2 mg/dL. He is not a transplant candidate. Which triplet regimen is the current standard of care for newly diagnosed transplant-ineligible myeloma per IMWG?
- A Melphalan + prednisone (MP)
- B Daratumumab + lenalidomide + dexamethasone (Dara-Rd) ✓
- C Bortezomib + cyclophosphamide + dexamethasone (VCD)
- D Thalidomide + melphalan + prednisone (MPT)
Correct answer: B. Daratumumab + lenalidomide + dexamethasone (Dara-Rd)
Explanation
The MAIA trial demonstrated that daratumumab + lenalidomide + dexamethasone (Dara-Rd) significantly improved progression-free survival compared to lenalidomide + dexamethasone alone in transplant-ineligible newly diagnosed myeloma (HR 0.56). Dara-Rd is now approved and recommended as standard frontline therapy for this population. Melphalan-based regimens (MP, MPT) are largely obsolete. VCD/CyBorD is used as a bridging/induction regimen.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.