We asked about patients with high-risk cytogenetics, specifically 17p deletion, and found induction treatment similar to those for patients at standard risk, the most common regimen being RVD, also used by both faculty. However, the approach to post-transplant maintenance is different, as 39% of oncologists and both faculty incorporate bortezomib, a practice that increased quickly after presentations of the HOVON-65 study, which used bortezomib-based induction and maintenance. Dr Munshi administers RVD maintenance, an approach described in a recent publication by Dr Sagar Lonial in Leukemia, and Dr Vij opts for lenalidomide and bortezomib without dexamethasone.

Sonneveld P et al. Bortezomib induction and maintenance treatment improves survival in patients with newly diagnosed multiple myeloma: Extended follow-up of the HOVON-65/GMMG-HD4 trial. Proc ASH 2013;Abstract 404.

Neben K et al. Administration of bortezomib before and after autologous stem cell transplantation improves outcome in multiple myeloma patients with deletion 17p. Blood 2012;119(4):940-8. Abstract

Scheid C et al. Bortezomib before and after autologous stem cell transplantation overcomes the negative prognostic impact of renal impairment in newly diagnosed multiple myeloma: A subgroup analysis from the HOVON-65/GMMG-HD4 trial. Haematologica 2014;99(1):148-54. Abstract

Nooka AK et al. Consolidation and maintenance therapy with lenalidomide, bortezomib and dexamethasone (RVD) in high-risk myeloma patients. Leukemia 2014;28(3):690-3. Abstract