We also asked about the approach to treatment for a 77-year-old patient with high-risk cytogenetics, specifically a 17p deletion, and most oncologists and the faculty would cautiously use RVD. Dr Vij notes that preemptive dose reductions may be considered for elderly or frail patients but that the poor short-term outcomes of myeloma in this situation must be balanced against the potential for toxicity.

Chng WJ et al. IMWG consensus on risk stratification in multiple myeloma. Leukemia 2014;28(2):269-77. Abstract

Mikhael JR et al. Management of newly diagnosed symptomatic multiple myeloma: Updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines 2013. Mayo Clin Proc 2013;88(4):360-76. Abstract