Dr. Nooka on Treatment Options for Transplant-Eligible and -Ineligible Multiple Myeloma

Ajay K. Nooka, MD, MPH, FACP, associate professor, Department of Hematology and Medical Oncology, Emory University School of Medicine, discusses current options for transplant-eligible and -ineligible patients with multiple myeloma.

Three-drug regimens using lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone (RVd) are used in transplant-ineligible patients with dose modifications, explains Nooka. For transplant-ineligible patients, the goal is to get the benefit from the triplet with minimal toxicity.

In transplant-eligible patients, transplant is used after a few cycles of induction treatment to gain the depth of response, says Nooka. In transplant-ineligible patients, however, a prolonged induction regimen is used to compensate for the transplant and use continuous treatment to gain similar benefits in transplant-ineligible patients.

RVd or RVd-lite is used for transplant-ineligible patients, but doublets are used in patients who cannot tolerate the other regimens. When using newer induction regimens with RVd and daratumumab (Darzalex), there is no overlapping toxicity with the doublets or triplets in the transplant-ineligible and -eligible settings, concludes Nooka.