Patient handout

Multiple Myeloma (initial diagnosis + chronic management)

PRODUCTION

1. Your condition

This handout is for multiple myeloma (initial diagnosis + chronic management). Your care team identified this based on: m-protein on spep/upep/serum free light chain (imwg 2014 rajkumar lancet oncol).

Other reasons your team may use this plan: crab: hypercalcemia / renal failure / anemia / bone lesion (imwg 2014 rajkumar lancet oncol); bone pain / pathological fracture (nccn 2024 mm); unexplained anemia + elevated total protein (nccn 2024 mm).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
daratumumab	16 mg/kg IV (or 1800 mg SC) weekly × 8 then q2w × 8 then q4w	IV/SC	weekly → q2w → q4w	GRIFFIN Voorhees Blood 2020 — added benefit to VRD; SC formulation daratumumab-hyaluronidase (NCCN 2024 MM)
bortezomib	1.3 mg/m² SC	SC	days 1, 4, 8, 11 of 21-day cycle	GRIFFIN Voorhees Blood 2020 backbone; SC route reduces neuropathy (Moreau Lancet Oncol 2011)
lenalidomide	25 mg PO daily days 1-14 of 21-day cycle	PO	daily × 14 of 21	GRIFFIN Voorhees Blood 2020; renal-dose adjust if eGFR <60 (NCCN 2024 MM)
dexamethasone	40 mg PO weekly (20 mg if >75)	PO	weekly	GRIFFIN Voorhees Blood 2020; 20 mg if age >75 (NCCN 2024 MM)

Plan: MM treatment by transplant eligibility (NCCN 2024 MM + IMWG 2020 Rajkumar + GRIFFIN Voorhees Blood 2020 + MAIA Facon NEJM 2019)

3. When to call your provider

Contact your care team if any of the following happen:

Hypercalcemia → ED + IV fluids + bisphosphonate (NCCN 2024 MM)
New back pain + neurologic deficit → STAT MRI for cord compression (NCCN 2024 MM)
AKI → cast nephropathy workup (NCCN 2024 MM)
Severe neuropathy on bortezomib → switch to SC or hold (Moreau Lancet Oncol 2011; NCCN 2024 MM)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Back pain + new neurologic deficit (weakness, sensory, sphincter) (NCCN 2024 MM)(life-threatening)
Serum Ca >12 with symptoms or Ca >14 (NCCN 2024 MM)
AKI + Bence Jones proteinuria + bland sediment (NCCN 2024 MM)
IgM/IgA spike + visual blurring / neurologic / bleeding triad (NCCN 2024 MM)(life-threatening)
Fever + hypotension + hypoxia after CAR-T (ASTCT 2019 Lee)
Encephalopathy / aphasia / seizure after CAR-T (ASTCT 2019 Lee)

5. Follow-up

Maintenance lenalidomide (CALGB 100104 McCarthy NEJM 2012); relapse surveillance; second primary malignancy screening; vaccinations; bone health (NCCN 2024 MM)

6. Sources

Guideline: NCCN 2024 Multiple Myeloma + IMWG 2014 Diagnostic Criteria (Rajkumar Lancet Oncol 2014) + IMWG 2020 Response Criteria (Kumar Lancet Oncol) + GRIFFIN (Voorhees Blood 2020) + MAIA (Facon NEJM 2019) + DETERMINATION (Richardson NEJM 2022) + SWOG S0777 (Durie Lancet 2017) + KRd (Stewart NEJM 2015) + CARTITUDE-4 (San-Miguel NEJM 2023)