![]() ![]() Thirty-five years after the introduction of high dose melphalan (HDM) followed by autologous stem cell transplantation (ASCT) as a treatment strategy for multiple myeloma (MM), ASCT remains the standard of care for newly diagnosed eligible patients. This review will focus on induction therapies prior to ASCT examining the latest data and guidelines on triplet and quadruplet regimens. Quadruplet regimens featuring anti-CD38 monoclonal antibodies are extremely promising and remain heavily investigated, as is the incorporation of more recent proteasome inhibitors such as carfilzomib. In fact, the updated 2021 European Haematology Association (EHA) and European Society for Medical Oncology (ESMO) clinical practice guidelines recommend the use of either lenalidomide-Vd (VRd), or daratumumab-thalidomide-Vd (Dara-VTd) as first-line options for transplant-eligible NDMM patients, and when not available, thalidomide-Vd (VTd) or cyclophosphamide-Vd (VCd) as acceptable alternatives. Doublet induction regimens have greatly fallen out of favor, with current international guidelines favoring triplet or quadruplet induction regimens built around the backbone of the proteasome inhibitor bortezomib and dexamethasone (Vd). Adequate induction is required to achieve good disease control and induce deep response rates while minimizing toxicity as a bridge to transplant. ![]() The current standard of care model for newly diagnosed fit multiple myeloma (NDMM) patients is the sequential treatment of induction, high dose melphalan, autologous stem cell transplantation (ASCT), and maintenance. ![]()
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