INDIAN MYELOMA ACADEMIC GROUPE

On Behalf of:

REGD OFFICE: Department of Hematology Army Hospital Research & Referral, Delhi

The information provided in this pamphlet is meant for patient education only. it should not be used as a reference tool for diagnosis or management. These are mere opinions of experts which may vary in different clinical situations.

INDIAN MYELOMA ACADEMIC GROUPE

Adjunctive Therapy

Renal Failure : dialysis/plasma exchange

Plasmacytomas /Cord Compression :

Radiotherapy/Vertebroplasty

Supportive care at all phases of therapy.

. Anemia

Transfusion Erythropoietin. Bone disease Bisphosphonate /Denosumab. Infections Antimicrobial

PATIENT INFORMATION BROCHURE

TREATMENT OF MULTIPLE MYELOMA

Phases of therapy

1. Induction 1(a). For transplant eligible patients:

Preferred options: Bortezomib/Lenalidomide/DexamethasoneBortezomib/Cyclophosphamide/DexamethasoneBortezomib/Thalidomide/DexamethasoneUseful for some patientsCarfilozomib/Lenalidomide/DexamethsaoneBortezomib/DexamethasoneThalidomide/Dexamethasone; Lenalidomide/Dexamethasone

1(b). For transplant ineligible patients:

Preferred Options

Bortezomib/ Lenalidomide /Dexamethasone

Bortezomib/ Cyclophosphamide/ DexamethasoneBortezomib/Thalidomide/ DexamethsoneUseful in some patientsBortezomib /dexamethasone;Lenalidomide/Dexamethasone

Thalidomide /DexamethasoneMelphalan /Prednisolone/Thalidomide

Melphalan/Prednisolone/Lenalidomide

Melphalan/Prednisolone/Bortezomib

Cyclophosphamide/Thalidomide/DexamethasoneCarfilzomib/Lenalidomide/Dexamethsaone

Follow up tests after every 2 to 4 cycles to look for response• Blood count; creatinine and calcium• Serum quantitative immunoglobulins• SPEP & SIFE(M band quantification)• Urine for total protein and M band• Serum Free Light Chain Assay (SFLC)• PET/CT scan (optional)• Bone marrow aspirate with MRD (optional)

3(a).Response Present

3(b).No Response/ Relapse/ Progression

Transplant eligible patients• Autologous Stem Cell Transplantfollowed by maintenance with or without consolidationTransplant ineligible patients • Continuous therapy till toleratedand best response is maintained

• Therapy as for previouslytreated myeloma:

• Daratumumab• Carfilzomib• Pomalidomide• Panobinostat• Chemotherapy

DoxorubicinCisplatinVincristine

• Repeat Autologousstem cell transplant

Incombination with

other drugs

Best response achieved/maintained

Follow up tests every 2 to 4 cycles to look

4. Maintenance • Bortezomib• Lenalidomide• Thalidomide• Interferon• Dexamethasone

Relapse

Treat for

relapse

3. Consolidation2. Follow Up