Induction regimen for transplant eligible multiple myeloma (MM) patients is 4-6 course of a triple drug regimen, typically with bortezomib, dexamethasone and cyclophosphamide (VCD), followed by ASCT. In some centres the alkylating agent may be substituted with thalidomide (VTD) or lenalidomide. Important factors determining which treatment to consider include effectiveness, tolerability and availability for first-line use.

The use of consolidation after ASCT may provide additional benefit, but this is still to be confirmed. It is being investigated in a number of trials, but Phase III data are needed and it is not routinely used outside of a clinical trial.
Maintenance with thalidomide has demonstrated improvements in progression free survival (PFS) and overall survival (OS). Lenalidomide has also demonstrated a significant PFS benefit, but not OS benefit. Maintenance is seen as an attractive treatment option for transplant MM candidates but is still confined to use in the clinical trial setting.
Delaying transplant may be a viable option for some patients. However, the recommendation is that all eligible patients should be offered ASCT.

This programme has been supported by an unrestricted educational grant from Janssen Pharmaceutica (A Johnson & Johnson Company).