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Multiple myeloma, newly diagnosed and fit for transplant

Multiple myeloma →

Four to six months of a four-drug combination, a stem cell transplant with a hospital stay of a few weeks, two more cycles, then maintenance tablets that continue for years while the disease is monitored down to a few cells in a million.

012345678Months from diagnosis · solid bar = shortest typical duration, hatched = up to the longest · arrow = continues for yearsPhaseDiagnosis and stagingDiagnosis and tests · 2-3 wkInduction: daratumumab + VRdSystemic therapy · 16-24 wkStem cell collectionCell therapy · 2-3 wkHigh-dose melphalan and autologous tr…Cell therapy · 4-6 wkConsolidationSystemic therapy · 8 wkMaintenanceSystemic therapy · yearsTransplant now or keep the cells for later?decision 1Diagnosis and testsSystemic therapyCell therapy
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Typical sequence for Newly diagnosed, transplant-eligible disease; durations are protocol values (cycle counts and lengths, fraction schedules, guideline follow-up intervals), not averages of real patients. Your team's plan will differ in detail.

Phase by phase

  1. 1. Diagnosis and staging
    weeks 0-3

    Serum and urine protein studies, free light chains, bone marrow biopsy with FISH for high-risk changes, whole-body low-dose CT or PET-CT.

    Source
  2. 2. Induction: daratumumab + VRd
    weeks 2-26

    Four to six 28-day cycles of daratumumab, bortezomib, lenalidomide and dexamethasone (PERSEUS).

    Source
    Decision: Transplant now or keep the cells for later?
    • Standard: transplant after induction (deeper responses, longer remission)
    • Delayed transplant with continued therapy is an option after a deep MRD-negative response (DETERMINATION showed no survival difference)
  3. 3. Stem cell collection
    weeks 18-21

    Growth factor (with plerixafor if needed) and apheresis of the patient's own stem cells.

    Source
  4. 4. High-dose melphalan and autologous transplant
    weeks 20-26

    Melphalan 200 mg/m2 then stem cell reinfusion; 2-3 weeks in hospital and several weeks of recovery.

    Source
  5. 5. Consolidation
    weeks 24-32

    Two further cycles of the induction combination.

    Source
  6. 6. Maintenance
    from week 32, continues for years

    Lenalidomide (with daratumumab in PERSEUS) until progression; MRD testing at about one year guides whether daratumumab can stop.

    Source

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