A 70-year-old man has IgG myeloma with revised ISS (R-ISS) Stage III. He is transplant-ineligible. Current NCCN preferred induction regimen is:

• A Thalidomide + dexamethasone (TD)
• B Melphalan + prednisolone (MP)
• C CHOP chemotherapy
• D Bortezomib + lenalidomide + dexamethasone (VRd) ✓

Explanation

VRd (bortezomib + lenalidomide + dexamethasone) is the current preferred induction regimen for both transplant-eligible and transplant-ineligible myeloma patients per NCCN and ESMO guidelines, based on the SWOG S0777 trial showing VRd superiority over Rd alone in terms of PFS and OS. For transplant-ineligible elderly patients, dose-reduced VRd or daratumumab-based quadruplets (Dara-VRd) are also considered. Melphalan-prednisolone is largely obsolete. Thalidomide + dexamethasone is inferior. CHOP is for lymphoma.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.