
Vincent Rajkumar/X
Jul 23, 2025, 10:25
Vincent Rajkumar: Approach to Newly Diagnosed Myeloma Has Become Streamlined
Vincent Rajkumar, Professor of Medicine at the Mayo Clinic in Rochester, Minnesota, shared on X:
“Approach to newly diagnosed myeloma has become streamlined. Bookmark.
Key points:
- Quads (when feasible) is standard of care after Griffin, Perseus, Imroz, Cepheus, Cassiopeia, Benefit RCTs.
- Delayed transplant is OK for patients with standard risk disease who are responding and tolerating induction well after IFM2009, Determination, and Midas RCTs.
- High risk patients need doublet maintenance. Either PI plus IMid or Anti CD38 plus Imid
Management of patients not eligible for transplant is the same except omit the transplant and give ~8 cycles of quad induction and then single or doublet maintenance based on risk.
Frail patients: Triplet induction is Ok. And some may only be able to tolerate (at least initially) mono therapy or doublet.
If acute cast nephropathy, Dara-VCd preferred and if it works well I don’t switch necessarily to Dara-VRd. Depends on many factors.”
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