Myeloma. Alternative Schedule: Bortezomib 1.3 mg/m² SC days 1, 4, 8, 11. Q21 days
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1 Palliative Regimens The following table lists the evidence-informed regimens (both IV and non-iv) for myeloma used in the palliative setting. It is expected that the prescribing oncologist will select the regimen from the list of evidence-informed regimens that is most appropriate for their patient taking account of a variety of disease-specific and patient-related factors. Regimens highlighted in red contain an expensive drug that is not currently publicly funded for the regimen and treatment intent. Regimen Code BMP Bortezomib 1.3 mg/m² IV or SC days 1, 8, 15, 22; Melphalan 9 mg/m² PO days 1-4; Prednisone 60 mg/m² PO days 1-4. Q35 days BORT Bortezomib 1.3 mg/m² IV or SC days 1, 8, 15, 22. Q35 days Alternative Schedule: Bortezomib 1.3 mg/m² SC days 1, 4, 8, 11. Can be given with or without dexamethasone: Dexamethasone 40 mg PO days 1-4 Regimen may also be used for light-chain amyloidosis CYBORD Cyclophosphamide 300 mg/m 2 PO days 1, 8, 15, 22; Bortezomib 1.5 mg/m 2 IV or SC days 1, 8, 15, 22; Dexamethasone 40 mg PO days 1-4, 9-12, (cycles 1 and 2), THEN Dexamethasone 40 mg weekly (cycles 3 and 4). Regimen may also be used for light-chain amyloidosis CYBORP Cyclophosphamide 300 mg/m 2 PO days 1, 8, 15, 22; Bortezomib 1.5 mg/m 2 IV or SC days 1, 8, 15; Prednisone 100 mg Q2 days.
2 CYCL Dose and frequency may vary, two options are: Cyclophosphamide 750 mg IV day 1. Q14-21 days Or Cyclophosphamide 500 mg IV day 1. Q7 days CYCL(PO) Can be given with or without Prednisone Dose and frequency may vary, two options are: Cyclophosphamide 500 mg PO weekly Or Cyclophosphamide 50 mg PO daily Can be given with or without Prednisone CYCLDEXALENA Cyclophosphamide 300 mg/m 2 PO days 1, 8, 15; Dexamethasone 40 mg PO days 1, 8, 15, 22 ; Lenalidomide 25 mg PO days 1 to 21. For amyloidosis CYCLDEXAPOMA Cyclophosphamide 400 mg PO days 1, 8, 15; Dexamethasone 40 mg (or 20 mg) PO days 1, 8, 15, 22 Pomalidomide 4 mg PO days 1 to 21. CYTAMTRX(IT) Schedule and frequency is variable, one option is: Methotrexate 12mg + Cytarabine 40mg IT +/- Hydrocortisone 15mg IT 2 injections/week for 4 weeks DEXA(PO) Dexamethasone 40 mg PO days 1-4, 9-12, DEXALENA Dexamethasone 40 mg IV/PO days 1, 8, 15, 22; Lenalidomide 25 mg PO days DEXAPOMA Pomalidomide 4 mg PO days 1-21 Dexamethasone mg PO days 1,8,15,22 LENA Lenalidomide 10 mg PO daily Note: For use as maintenance treatment post-asct MELPDEXA Melphalan 10 mg/m 2 PO days 1-4; Dexamethasone 40 mg PO days 1-4. Note: For use in light-chain amyloidosis
3 Regimen Code MELPPRED Melphalan 8-9 mg/m² PO days 1-4; Prednisone 100 mg PO days 1-4. MPT Melphalan 4 mg/m² PO days 1-7; Prednisone 40 mg PO days 1-7; Thalidomide 100 mg PO days Alternative Schedule: Melphalan 9 mg/m 2 PO days 1-4; Prednisone 100 mg PO days 1-4; Thalidomide 200 mg PO daily. Q42 days MTRX(IT) Methotrexate 12 mg IT Schedule and frequency depends on treatment intent and disease status (i.e. prophylactic or established CNS involvement) PMDR Pamidronate 90 mg IV day 1. THAL Thalidomide mg PO daily VAD VinCRIStine 0.4 mg/day CIV days 1-4 DOXOrubicin 9 mg/m 2 /day CIV days 1-4 Dexamethasone 40 mg/day PO days 1-4, 9-12, Note: Old regimen for myeloma but may be used if one exhausts other treatment options ZOLE Zoledronic Acid 4 mg IV day 1 BORT(MNT) Alternative Schedule: Zoledronic acid 4 mg IV day 1. Q84 days Bortezomib 1.3 mg/m 2 SC day 1 Not currently publicly funded for this regimen and intent. Q14 days Note: Starts 3-4 months post-asct for up to 2 years
4 Regimen Code BORTDEXADARA Cycles 1-3: Bortezomib 1.3 mg/m 2 SC days 1, 4, 8, 11 Not currently publicly funded for this Daratumumab 16 mg/kg IV days 1, 8, 15 Not currently publicly funded for this Dexamethasone 20 mg PO days 1, 2, 4, 5, 8, 9, 11, 12. Cycles 4-8: Bortezomib 1.3 mg/m 2 SC days 1, 4, 8, 11; Daratumumab 16 mg/kg IV day 1; Dexamethasone 20 mg PO days 1, 2, 4, 5, 8, 9, 11, 12. BORTDEXALENA Cycle 9 and beyond: Daratumumab 16 mg/kg IV day 1; Bortezomib 1.3 mg/m 2 SC days 1, 4, 8, 11 Not currently publicly funded for this Dexamethasone 40 mg days 1, 8, 15; Lenalidomide mg PO days 1-14 Not currently publicly funded for this regimen Alternative Bortezomib schedule: Bortezomib mg/m 2 SC weekly days 1, 8, 15 BORTDEXAPOMA Bortezomib 1.3 mg/m 2 SC or IV days 1, 8, 15, 22 Not currently publicly funded for this Dexamethasone 40 mg PO days 1, 8, 15, 22; Pomalidomide 4 mg PO daily days 1 to 21 Not currently publicly funded for this regimen Regimen may also be used for light-chain amyloidosis CARF Cycle 1: Carfilzomib 20mg/m 2 IV days 1, 2, 8, 9, 15, 16 Not currently publicly funded for this regimen and intent Q28days Cycles 2-12: Carfilzomib 27 mg/m 2 IV days 1, 2, 8, 9, 15, 16 Not currently publicly funded for this regimen and intent CARFDEXA Cycle 1: Carfilzomib 20 mg/m 2 IV days 1, 2 Not currently publicly funded for this regimen and intent; Carfilzomib 56 mg/m 2 IV days 8, 9, 15, 16 Not currently publicly funded for this
5 Dexamethasone 20 mg PO/IV days 1, 2, 8, 9, 15, 16, 22 and 23. Cycle 2 and beyond: Carfilzomib 56 mg/m 2 IV days 1, 2, 8, 9 15, 16 Not currently publicly funded for this Dexamethasone 20 mg PO/IV days 1, 2, 8, 9, 15, 16, 22 and 23. CARFDEXALENA Cycle 1: Carfilzomib 20 mg/m 2 IV days 1, 2 Not currently publicly funded for this regimen and intent Carfilzomib 27 mg/m 2 IV days 8, 9, 15, 16 Not currently publicly funded for this regimen and intent Dexamethasone 40 mg PO/IV days 1, 8, 15, 22; CYCLDEXATHAL Cycle 2-12: Carfilzomib 27 mg/m 2 IV days 1, 2, 8, 9, 15, 16 Not currently publicly funded for this Dexamethasone 40 mg PO/IV days 1, 8, 15, 22; Cycles 13-18: Carfilzomib 27 mg/m 2 IV days 1, 2, 15, 16 Not currently publicly funded for this Dexamethasone 40 mg PO/IV days 1, 8, 15, 22; Q28days Cycle 19 and beyond: (**Report as Regimen Code: DEXALENA**) Dexamethasone 40 mg IV/PO days 1, 8, 15, 22. and intent Cyclophosphamide 500 mg PO once weekly Thalidomide 200 mg PO daily - Not currently publicly funded for this regimen and intent Dexamethasone 40 mg PO days 1-4 and 9-12 For light-chain amyloidosis DARA Cycles 1-2: Daratumumab 16 mg/kg IV days 1, 8, 15, 22 not currently publicly funded for this regimen
6 Cycles 3-6: Daratumumab 16 mg/kg IV days 1, 15. Cycle 7 and beyond: Daratumumab 16 mg/kg IV day 1. DARADEXALENA Cycles 1-2: Daratumumab 16 mg/kg IV days 1, 8, 15, 22 not currently publicly funded for this Dexamethasone 40 mg* PO days 1, 8, 15, 22; Lenalidomide 25 mg PO days 1-21 not currently publicly funded for this regimen Cycles 3-6: Daratumumab 16 mg/kg IV days 1, 15; Dexamethasone 40 mg* PO days 1, 8, 15, 22; Lenalidomide 25 mg PO days Cycle 7 and beyond: Daratumumab 16 mg/kg IV day 1; Dexamethasone 40 mg* PO days 1, 8, 15, 22; Lenalidomide 25 mg PO days Note: *On daratumumab dosing days, half the dexamethasone dose was administered as a pre-medication on the day of the infusion and half the dose the day after. DEXAIXAZLENA Ixazomib 4 mg PO days 1, 8, 15 not currently publicly funded for this regimen and intent; Lenalidomide 25 mg PO days 1-21 not currently publicly funded for this regimen and intent; Dexamethasone 40 mg PO days 1, 8, 15, 22. PAD/VCD Cycles 1 and 3: Bortezomib 1.3 mg/m 2 SC days 1, 4, 8, 11; Pegylated Liposomal DOXOrubicin 30 mg/m 2 IV day 4 not currently publicly funded for this Dexamethasone 40 mg PO days 1, 4, 8, 11. Cycles 2 and 4: Bortezomib 1.3 mg/m 2 SC days 1, 4, 8, 11; Cyclophosphamide 300 mg/m 2 PO days 1, 8; Dexamethasone 40 mg PO days 1, 4, 8, 11.
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