NOTE: BOTH DARATUMUMAB AND DARATUMUMAB/HYALURONIDASE-FIHJ WILL BE PATHWAY.
| Evolent Pathways | Febrile Neutropenic Risk | Emetogenic Risk | References | ||
|---|---|---|---|---|---|
| TRANSPLANT CANDIDATES | |||||
Initial Therapy |
lenalidomide, bortezomib and steroid (RVd or VRd) |
Low | Low |
|
|
daratumumab, lenalidomide, bortezomib and dexamethasone (D-RVd) |
Low | Minimal |
|
||
cyclophosphamide, bortezomib and steroid (CyBorD) |
Low | High |
|
||
Maintenance |
lenalidomide |
Low | Low |
|
|
bortezomib |
Low | Low |
|
||
| NON-TRANSPLANT CANDIDATES | |||||
Initial Therapy |
lenalidomide, bortezomib and steroid (RVd or VRd) |
Low | Low |
|
|
daratumumab, lenalidomide and steroid (DRd) |
Low | Low |
|
||
cyclophosphamide, bortezomib and steroid (CyBorD) |
Low | High |
|
||
Maintenance |
lenalidomide |
Low | Low |
|
|
bortezomib |
Low | Low |
|
||
| THERAPY FOR PREVIOUSLY TREATED MULTIPLE MYELOMA | |||||
Subsequent Therapy |
daratumumab, bortezomib and steroid (DVd) |
Low | Low |
|
|
daratumumab, lenalidomide and steroid (DRd) |
Low | Low |
|
||
daratumumab, carfilzomib and steroid (DKd) |
Low | Low |
|
||
daratumumab, pomalidomide and steroid (DPd) |
Low | Low |
|
||
elotuzumab, pomalidomide and steroid (EPd) |
Low | Low |
|
||
carfilzomib, lenalidomide and steroid (KRd) |
Low | Low |
|
||
carfilizomib, pomalidomide and steroid (KPd) |
Low | Low |
|
||
cyclophosphamide, bortezomib and steroid (CyBorD) |
Low | High |
|
||
daratumumab *after progression on 3 prior lines of therapy or double refractory* |
Low | Low |
|
||
CAR T-cell Therapy: after one prior line of therapy |
ciltacabtagene autoleucel (Carvykti) |
Low | Low |
|
|
CAR T-cell Therapy: after two prior lines of therapy |
idecabtagene vicleucel (Abecma) |
Intermediate | Low |
|
|
CAR T-cell Therapy: after 3 prior lines of therapy |
ciltacabtagene autoleucel (Carvykti) |
Low | Low |
|
|
idecabtagene vicleucel (Abecma) |
Low | Low |
|
||
BiTE (bispecific antibodies) Therapy: after 3 prior lines of therapy |
teclistamab (Tecvayli) |
Intermediate | Minimal |
|
|
talquetamab (Talvey) |
Low | Minimal |
|
||
elranatamab (Elrexfio) |
Low | Low |
|
||
linvoseltamab (Lynozyfic) |
High | Minimal |
|
||
Best Supportive Care or Clinical Trial |
Not Applicable | Not applicable |
|
||
Initial Therapy
lenalidomide, bortezomib and steroid (RVd or VRd)
daratumumab, lenalidomide, bortezomib and dexamethasone (D-RVd)
cyclophosphamide, bortezomib and steroid (CyBorD)
Maintenance
lenalidomide
bortezomib
Initial Therapy
lenalidomide, bortezomib and steroid (RVd or VRd)
daratumumab, lenalidomide and steroid (DRd)
cyclophosphamide, bortezomib and steroid (CyBorD)
Maintenance
lenalidomide
bortezomib
Subsequent Therapy
daratumumab, bortezomib and steroid (DVd)
daratumumab, lenalidomide and steroid (DRd)
daratumumab, carfilzomib and steroid (DKd)
daratumumab, pomalidomide and steroid (DPd)
elotuzumab, pomalidomide and steroid (EPd)
carfilzomib, lenalidomide and steroid (KRd)
carfilizomib, pomalidomide and steroid (KPd)
cyclophosphamide, bortezomib and steroid (CyBorD)
daratumumab *after progression on 3 prior lines of therapy or double refractory*
CAR T-cell Therapy: after one prior line of therapy
ciltacabtagene autoleucel (Carvykti)
CAR T-cell Therapy: after two prior lines of therapy
idecabtagene vicleucel (Abecma)
CAR T-cell Therapy: after 3 prior lines of therapy
ciltacabtagene autoleucel (Carvykti)
idecabtagene vicleucel (Abecma)
BiTE (bispecific antibodies) Therapy: after 3 prior lines of therapy
teclistamab (Tecvayli)
talquetamab (Talvey)
elranatamab (Elrexfio)
linvoseltamab (Lynozyfic)
Best Supportive Care or Clinical Trial
| Regimen | Alternative | References | |||
|---|---|---|---|---|---|
| LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES | |||||
Initial therapy |
** ixazomib, lenalidomide and dexamethasone ** |
Alternatives: bortezomib + lenalidomide + dexamethasone |
|||
Initial therapy |
** daratumumab, carfilzomib, lenalidomide and dexamethasone ** |
Alternatives: daratumumab + lenalidomide + bortezomib + dexamethasone |
|||
Subsequent therapy |
** selinexor, daratumumab and dexamethasone ** |
Alternatives: carfilzomib + pomalidomide + dexamethasone |
|||
** belantamab mafodotin-blmf ** (if available through compassionate use program) |
Alternatives: varies |
||||
Initial therapy
** ixazomib, lenalidomide and dexamethasone **
Initial therapy
** daratumumab, carfilzomib, lenalidomide and dexamethasone **
Subsequent therapy
** selinexor, daratumumab and dexamethasone **
** belantamab mafodotin-blmf ** (if available through compassionate use program)