Multiple myeloma, newly diagnosed and fit for transplant

Multiple myeloma →

Four to six months of a four-drug combination, a stem cell transplant with a hospital stay of a few weeks, two more cycles, then maintenance tablets that continue for years while the disease is monitored down to a few cells in a million.

Download

Typical sequence for Newly diagnosed, transplant-eligible disease; durations are protocol values (cycle counts and lengths, fraction schedules, guideline follow-up intervals), not averages of real patients. Your team's plan will differ in detail.

Phase by phase

1. Diagnosis and staging
weeks 0-3
Serum and urine protein studies, free light chains, bone marrow biopsy with FISH for high-risk changes, whole-body low-dose CT or PET-CT.
CT (computed tomography)FDG PET
Source
2. Induction: daratumumab + VRd
weeks 2-26
Four to six 28-day cycles of daratumumab, bortezomib, lenalidomide and dexamethasone (PERSEUS).
DaratumumabBortezomibLenalidomideMonoclonal antibodies
Source
Decision: Transplant now or keep the cells for later?
- Standard: transplant after induction (deeper responses, longer remission)
- Delayed transplant with continued therapy is an option after a deep MRD-negative response (DETERMINATION showed no survival difference)
3. Stem cell collection
weeks 18-21
Growth factor (with plerixafor if needed) and apheresis of the patient's own stem cells.
Source
4. High-dose melphalan and autologous transplant
weeks 20-26
Melphalan 200 mg/m2 then stem cell reinfusion; 2-3 weeks in hospital and several weeks of recovery.
Melphalan (including hepatic delivery system)
Source
5. Consolidation
weeks 24-32
Two further cycles of the induction combination.
DaratumumabBortezomibLenalidomide
Source
6. Maintenance
from week 32, continues for years
Lenalidomide (with daratumumab in PERSEUS) until progression; MRD testing at about one year guides whether daratumumab can stop.
LenalidomideDaratumumabMRD / molecular residual disease testing
Source

Sources

Phase by phase

1. Diagnosis and staging

weeks 0-3

Serum and urine protein studies, free light chains, bone marrow biopsy with FISH for high-risk changes, whole-body low-dose CT or PET-CT.

CT (computed tomography)FDG PET

Source

2. Induction: daratumumab + VRd

weeks 2-26

Four to six 28-day cycles of daratumumab, bortezomib, lenalidomide and dexamethasone (PERSEUS).

DaratumumabBortezomibLenalidomideMonoclonal antibodies

Source

Decision: Transplant now or keep the cells for later?

Standard: transplant after induction (deeper responses, longer remission)
Delayed transplant with continued therapy is an option after a deep MRD-negative response (DETERMINATION showed no survival difference)

3. Stem cell collection

weeks 18-21

Growth factor (with plerixafor if needed) and apheresis of the patient's own stem cells.

Source

4. High-dose melphalan and autologous transplant

weeks 20-26

Melphalan 200 mg/m2 then stem cell reinfusion; 2-3 weeks in hospital and several weeks of recovery.

Melphalan (including hepatic delivery system)

Source

5. Consolidation

weeks 24-32

Two further cycles of the induction combination.