The Fellow on Call: The Heme/Onc Podcast Episode 145: Myeloma Series, Pt. 6 - First line treatment of Multiple Myeloma (2026)
Jan 21, 2026
A deep dive into first-line therapy for newly diagnosed multiple myeloma. They compare triplet versus quadruplet regimens and when to consider transplant. Discussion covers risk stratification, melphalan dosing, and infection and safety trade-offs with modern combinations. Trial data like Perseus, MASTER, Cepheus, and others shape practical treatment planning.
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Three Phases Define Frontline Strategy
- Frontline myeloma treatment has three phases: induction, consolidation, and maintenance.
- Deeper induction responses predict longer progression-free survival and better long-term outcomes.
Decide Transplant By Fitness, Not Just Age
- Assess transplant eligibility by physiologic reserve rather than strict age cutoffs.
- Consider melphalan dose reductions for older or renally impaired candidates when planning transplant.
Anti‑CD38 Is Now Core To Induction
- Modern induction combines an anti-CD38 antibody plus dexamethasone and at least one IMiD or proteasome inhibitor.
- Quadruplets add both an IMiD and a proteasome inhibitor to deepen responses versus triplets.