A 72-year-old woman is diagnosed with multiple myeloma: IgG kappa, serum M-protein 4.8 g/dL, bone marrow plasma cells 45%, creatinine 1.3 mg/dL, haemoglobin 9.2 g/dL, and calcium 10.8 mg/dL. She is not a transplant candidate. Which triplet regimen is the current standard of care for frontline treatment?

• A Melphalan + prednisolone + thalidomide (MPT)
• B Thalidomide + dexamethasone
• C Bortezomib + lenalidomide + dexamethasone (VRd) ✓
• D Cyclophosphamide + vincristine + doxorubicin + dexamethasone (CVAD)

Explanation

VRd (bortezomib + lenalidomide + dexamethasone) is the standard frontline regimen for transplant-ineligible myeloma, supported by the SWOG S0777 trial demonstrating superior PFS and OS compared with Rd alone. Daratumumab-VRd (D-VRd) is now the preferred quadruplet regimen per MAIA and PERSEUS trials in eligible patients. MPT is an older regimen with inferior outcomes. Thalidomide-dex is suboptimal. CVAD is not a standard myeloma 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.