69y male with high risk myeloma (1q gain) in renal failure, GFR 9. Started velcade yesterday. He is ill due to myeloma only, excellent health premorbidly. I would say potentially transplant eligible. Would you do cybordD until renal function stabilizes, DaraRD or Dara-VRD?What do you typically chose as induction in these borderline transplant patients and how do you maintain if they never get to transplant?

Multiple Myeloma Specialist

If patient is admitted, we typically start with CyborD as daratumumab is usually difficult to get approved. If outpatient, would suggest dara/CyBorD and then transition to Dara-RVD once renal function stabilizes. Transplant candidacy would somewhat depend on how the renal function does. I typically do not take patients to transplant anymore if I have to dose reduce melphalan. We have so many other immune and combination therapies now and prefer to go that route at the time of relapse instead. After 8-12 cycles of induction, typically would do combination maintenance with daratumumab and velcade or daratumumab and revlimid depending on tolerability.