Vincent Rajkumar, Professor of Medicine at the Mayo Clinic in Rochester, shared on X:
“Updated FAQs on newly diagnosed multiple myeloma for 2026!
1. Which frontline regimen to use?
Quad regimen, either Dara-VRd or Isa-VRd
2. How long to give the Quad regimen?
- 4 months and then transplant, or
- 6 months if transplant ineligible or deferred
3. What maintenance after initial therapy?
- Standard risk: Dara or Isa plus Lenalidomide
- High Risk: Dara or Isa plus Lenalidomide; or bortezomib plus Lenalidomide
4. How long to give maintenance?
- Standard risk: Lenalidomide for 2 years and stop; Dara or Isa till progression.
- High risk: Till progression.
5. Is transplant still recommended in eligible patients?
- High risk myeloma: Yes.
- Standard risk: Early vs delayed- Shared decision making based on age and patient preference.
6. Definition of High risk myeloma?
Del 17p is high risk by itself
All the others (4;14, 1q, 1p, etc) all need two abnormalities together to call as high risk.
(P53 mutation and bi-allelic del 1p also high risk; but small numbers)
Check out myelomarisk.com to make this assessment easily.
7. What about CART or bispecifics in newly diagnosed myeloma.
- Totally Investigational. Done only on approved clinical trials
8. What about frail patients who cannot tolerate quadruplet?
Triplet: DaraRd or IsaRd; if that’s not possible or safe: Rd or even single agent Dara may sometimes be needed at least initially till performance status improves.
9. What about patients with acute renal failure?
Prefer Dara-VCd rather than Dara-VRd
10. How long to give the Dex?
Keep Dex only for initial 4-6 months. No dex in maintenance.”
Read also “ENDURANCE Trial: 2 Years of Lenalidomide Maintenance Matches Continuous Therapy in Standard-Risk Multiple Myeloma” on OncoDaily.
