Long-term treatment plan for previous pt?


Long-term treatment plan for previous pt?

What is your long-term treatment approach for this patient — What is the duration of induction therapy that you would recommend, and would you modify your approach over time for any reason?

 

Andrzej J Jakubowiak, MD, PhD
Director, Myeloma Program
Professor, Department of Medicine
Section of Hematology/Oncology
University of Chicago Medical Center
Chicago, Illinois
Answer: Treat until PD, step-down dose mod. after cycle 4

Again, I would approach the patient at high risk in the same manner as I would the patient with standard risk.

Ola Landgren, MD, PhD
Chief, Myeloma Service
Memorial Sloan Kettering
Cancer Center
New York, New York
Answer: Treat until CR or 2 cycles after response plateau LEN maint. until PD

My treatment approach would be the same for a patient with standard- or high-risk disease.

Philip L McCarthy, MD
Professor, Medical Oncology
Professor of Oncology and
Internal Medicine
BMT Program
Roswell Park Cancer Institute and
State University of
New York at Buffalo
Buffalo, New York
Answer: Treat until PD, dose reduce if needed

For a patient who is at high risk I also continue induction therapy until disease progression if treatment is well tolerated. I would reduce the dose of an agent if needed for tolerability.

Joseph Mikhael, MD, MEd
Associate Dean, Mayo School of
Graduate Medical Education
Deputy Director - Education
Mayo Clinic Cancer Center
Associate Professor
Mayo College of Medicine
Mayo Clinic in Arizona
Scottsdale, Arizona
Answer: Treat until PD, dose reduce if needed

For a patient with high-risk disease, I would also continue therapy until relapse. But I would consider administering bortezomib every other week instead of every week. We don’t have a lot of evidence to support the use of bortezomib for more than a year in older patients.

Philippe Moreau, MD
Professor of Hematology
Head, Hematology Department
University Hospital Hôtel-Dieu
Nantes, France
Answer: If VMP, treat for 12 cycles observation If len/low-dose dex, treat until PD

My approach is the same whether a patient is considered to be at standard risk or high risk.

Antonio Palumbo, MD
Chief, Myeloma Unit
Division of Hematology
University of Torino
Torino, Italy
Answer: Treat for 8-9 cycles observation

I follow the same approach for patients irrespective of their risk status.

Noopur Raje, MD
Director, Center for Multiple Myeloma
Massachusetts General Hospital Cancer Center 
Associate Professor of Medicine
Harvard Medical School
Boston, Massachusetts
Answer: Treat for 8 cycles 3 cycles consolidation LEN maint. indefinitely

My recommendation is the same for patients irrespective of their risk status.

Paul G Richardson, MD
Clinical Program Leader
Director of Clinical Research
Jerome Lipper Multiple
Myeloma Center
Department of Medical Oncology
Dana-Farber Cancer Institute
RJ Corman Professor of Medicine
Harvard Medical School
Boston, Massachusetts
Answer: Treat until PD, dose reduce if needed

I would approach the patient with high-risk MM in the same manner as I do the patient with standard-risk MM.