Multiple myeloma
A malignant plasma cell disease of the bone marrow producing monoclonal protein (M-protein). Classic CRAB features: hypercalcemia, renal failure, anemia, bone lesions. IMWG 2014 and ESMO 2024 base therapy on transplant eligibility. In transplant-eligible patients: triple induction (bortezomib + lenalidomide + dexamethasone, or with daratumumab) → autologous stem cell transplant → lenalidomide maintenance. In transplant-ineligible patients: extended regimens with bortezomib, lenalidomide, daratumumab.
ICD-10 C90.02 drugs
Also known as: Kahler disease, Plasma cell myeloma
Drugs used for this condition
- ALenalidomideFirst line · Immunomodulatory drug (IMiD), thalidomide derivativeFoundation component of multiple myeloma therapy per IMWG 2014 and ESMO 2024. In newly diagnosed patients, lenalidomide is in triplet and quadruplet induction (VRd: bortezomib + lenalidomide + dexamethasone; D-VRd: with daratumumab). Lenalidomide maintenance 10 mg for 21 days of 28 after autologous transplant doubles progression-free survival (CALGB 100104). In relapsed myeloma: combinations with carfilzomib, elotuzumab, ixazomib, daratumumab.
- BPomalidomideThird line · Immunomodulatory drug (IMiD)Relapsed or refractory multiple myeloma in adults previously treated with at least two lines including lenalidomide and bortezomib, with progression on the last line. Per IMWG 2024 and SEHH 2023 – third-line and beyond, combined with dexamethasone plus one of: daratumumab, isatuximab, elotuzumab, bortezomib, cyclophosphamide. Dose: 4 mg orally once daily on days 1–21 of a 28-day cycle. Adjust for neutropenia and thrombocytopenia.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit