It is the consensus of the Haematology Reference Committee that this protocol is not considered best practice for this patient population.
Treatment schedule summary
Cycle 1 to 3
Drug |
Dose |
Route |
Day |
Dexamethasone |
40 mg ONCE a day |
PO |
1 to 4, 9 to 12, 17 to 20 |
Bortezomib * |
1.3 mg/m2 |
Subcut |
1, 4, 8, 11 |
DOXOrubicin ** |
36 mg/m2 |
CIV via pump over 96 hours |
1 |
* The once weekly bortezomib protocol with 1.5 mg/m2 is associated with similar response rates to twice weekly bortezomib but with much less grade 3-4 events.
** DOXOrubicin may alternatively be given at a dose of 20 mg/m2 on days 1 AND 4 (total dose of 40 mg/m2).
Frequency: 28 days
Cycles: 3 followed by intensification with high dose melphalan and autologous stem cell transplant; followed by maintenance with bortezomib every 2 weeks for 2 years
- Notes:
-
It is the consensus of the reference committee that a 20 mg/week starting dose of dexamethasone should be considered in patients > 75 years.