Multiple Myeloma Drug Summary

Last updated: 20 June 2025

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Cancer Immunotherapy/Immunomodulating Agents

Content on this page:

Cancer Immunotherapy/Immunomodulating Agents

Cancer Immunotherapy/Immunomodulating Agents


Drug Dosage Remarks
Lenalidomide Patients eligible for AHCT:
In combination with Bortezomib and Dexamethasone:
25 mg PO 24 hourly on days 1-14 of a 21-day cycle
Patients ineligible for AHCT:
In combination with Dexamethasone: 25 mg PO 24 hourly on days 1-21 of a 28-day cycle
In combination with Melphalan and Prednisone: 10 mg PO 24 hourly on days 1-21 of a 28-day cycle x 9 cycles
In combination with Bortezomib and Dexamethasone: 25 mg PO 24 hourly on days 1-14 of a 21-day cycle x 8 cycles
Post-AHCT:
Initial dose: 10 mg PO 24 hourly
Maintenance dose: 15 mg/day PO 3 months after initiation of therapy if tolerated
Previously treated:
25 mg PO 24 hourly on days 1-21 of a 28-day cycle
Continue until disease progression and modify dose according to toxicity 		Adverse Reactions
  • CV effects (MI, pulmonary embolism, cerebrovascular accident [CVA], deep vein thrombosis [DVT]); Dermatologic effects (peripheral edema, pruritus, dry skin, hyperhidrosis, skin hyperpigmentation, alopecia, toxic epidermal necrolysis, erythema multiforme); Respiratory effects (pneumonia, dyspnea, cough, interstitial pneumonitis); Musculoskeletal effects (arthralgia, pain, myalgia, muscle cramps, myopathy); Ophthalmologic effects (cataracts, blurred vision, loss of vision); GI effects (cholestatic and mixed cytolytic/cholestatic hepatitis, pancreatitis, acute hepatic failure); Other effects (fatigue, electrolyte disturbances, Stevens-Johnson syndrome)
Special Instructions
  • Contraindicated in newly diagnosed patients with absolute neutrophil count (ANC) <1.5 x 109/L and platelet count of <50 x 109/L ineligible for AHCT, ANC <1 x 109/L and/or platelet count <75 x 109/L in post-AHCT patients, and ANC <1.0 x 109/L and/or platelet count <75 x 109/L in previously treated MM patients
  • Use with caution in patients with history of thrombosis; smokers; patients with hypertension, hyperlipidemia, high tumor burden, renal impairment
Pomalidomide In combination with Dexamethasone: 4 mg PO 24 hourly x 21 days of a 28-day cycle
In combination with Bortezomib or Carfilzomib and Dexamethasone:
4 mg PO 24 hourly on days 1-14 of a 21-day cycle or
4 mg PO 24 hourly on days 1-21 of a 28-day cycle
Continue until disease progression and modify dose according to toxicity
 Adverse Reactions
  • Respiratory effects (interstitial lung disease, pulmonary edema, pulmonary embolism, dyspnea); CV effects (congestive cardiac failure, DVT); Hematologic effects (anemia, neutropenia, thrombocytopenia, leukopenia); GI effects (diarrhea, nausea); Other effects (pyrexia, dizziness, confusion, hypersensitivity reactions, secondary malignancies, tumor lysis syndrome, reactivation of hepatitis B)
Special Instructions
  • Use with caution in patients with severe renal impairment, mild to moderate hepatic impairment, cardiac disease or cardiac risk factors, thromboembolism, history of hepatitis B infection, serious hypersensitivity reactions, high tumor burden, ≥2 grade 2 peripheral neuropathy
  • Monitor CBC weekly for the 1st 8 weeks of therapy and monthly thereafter; renal function, thyroid function at baseline and every 2-3 months during treatment, LFT monthly
Thalidomide In combination with Melphalan and Prednisone: 100-200 mg/day PO
Max dose: 12 cycles of 6 weeks
In combination with Dexamethasone:
200 mg/day PO for 4 cycles every 4 weeks + Dexamethasone 40 mg/day PO on days 1-4, 9-12, 17-20 every 4 weeks or
40 mg/day PO on days 1, 8, 15 and 22 every 4 weeks
In combination with Bortezomib and Dexamethasone:
100 mg PO 24 hourly on days 1-14 then 200 mg PO 24 hourly on days 15-21 of a 4-week cycle 		Adverse Reactions
  • CNS effects (drowsiness, somnolence, peripheral neuropathy, dizziness, psychological abuse and dependence); CV effects (orthostatic hypotension, bradycardia); Other effects (severe birth defects, fetal death, neutropenia, increase of viral load in HIV-infected patients, hypersensitivity reaction, rash, physical abuse)
Special Instructions
  • Should be taken on an empty stomach or at least 1 hour after a meal
  • Use with caution in patients with peripheral neuropathy, dizziness, orthostatic hypotension, history of seizures, Lapp-lactase deficiency, glucose-galactose malabsorption, and those who require mental alertness (ie driving, machine operation)
  • Monitor WBC count regularly

Corticosteroid Hormones


Drug Dosage Remarks
Dexamethasone In combination with anti-cancer agents: 0.05-0.2 mg/kg/day PO Adverse Reactions
  • Metabolic effects (decreased glucose tolerance, negative nitrogen and Ca balance, Na and fluid retention, K loss, hypokalemic alkalosis); GI effects (gastric/duodenal ulcer, abdominal distention); Dermatologic effects (impaired wound healing, skin atrophy, striae, petechiae, ecchymoses, bruising, facial erythema, increased sweating, acne); Musculoskeletal effects (myopathy, osteoporosis, aseptic necrosis of femoral and humeral heads, premature epiphyseal closure); CNS effects (psychic disturbances ranging from euphoria to frank psychotic manifestations, convulsions); Ophthalmologic effects (glaucoma, increased intraocular pressure [IOP], posterior subcapsular cataracts); Other effects (Cushing-like syndrome, hirsutism, menstrual irregularities, hypertension, increased susceptibility to infections, decreased responsiveness to vaccination and skin tests)
Special Instructions
  • Contraindicated in patients with gastric and duodenal ulcers, systemic fungal infection, viral infection (eg varicella and herpes genitalia infections), glaucoma
  • Use with caution in patients with latent or overt cardiac failure, renal impairment, hypertension, migraine, fluid retention, osteoporosis, history of psychotic illness and latent TB, parasitic infestation (eg amoebiasis, incomplete statural growth)
  • Monitor glucose metabolism
Prednisone In combination with anti-cancer agents: 
25-50 mg PO every other day

Cytotoxic Chemotherapy


Drug Dosage Remarks
Bendamustine
In combination with Prednisone:
120-150 mg/m2 BSA IV infusion over 30-60 minutes on days 1 and 2 combined with Prednisone 60 mg/m2 IV BSA on days 1-4 of 4-week cycles
Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, constipation, stomatitis); Hematologic effects (lymphopenia, anemia, leukopenia, thrombocytopenia, neutropenia); Other effects (anorexia, malignant/premalignant disease, pyrexia, cough, headache, fatigue, weight loss, rash)
  • Potentially fatal: Myelosuppression, tumor lysis syndrome which may lead to acute renal failure, infections (eg sepsis, pneumonia, septic shock), Stevens-Johnson syndrome, toxic epidermal necrolysis
Special Instructions
  • Contraindicated in patients with jaundice, severe bone marrow suppression, low leukocyte or platelet count, severe hepatic impairment and those who underwent major surgery <30 days prior to treatment
  • Use with caution in patients with mild-moderate hepatic and renal impairment
Busulfan In combination with Cyclophosphamide:
0.8 mg/kg IV infusion via central venous catheter over 120 minutes 6 hourly x 4 days (total of 16 doses)
Adverse Reactions
  • CV effects (tachycardia, hypertension, thrombosis, vasodilatation, edema, chest pain); GI effects (nausea/vomiting, stomatitis, diarrhea, abdominal pain, abdominal enlargement, dyspepsia, constipation, dry mouth, rectal disorder); Metabolic effects (hypomagnesemia, hyperglycemia, hypokalemia, hypocalcemia); Hepatic effects (hyperbilirubinemia, increased ALT); Respiratory effects (dyspnea, epistaxis, cough, rhinitis, lung disorder); CNS effects (insomnia, anxiety, headache, chills, dizziness, depression, headache); Other effects (fever, asthenia, pain, rash, pruritus, increased creatinine)
Special Instructions
  • Administer antiemetics prior to first dose of Busulfan
  • Premedicate with anticonvulsants 12 hours before administration up to 24 hours after the last dose
  • Avoid concomitant administration of live vaccines
  • Use with caution in patients with prolonged myelosuppression, history of or predisposition to seizures, prior chemotherapy of ≥3 cycles, prior stem cell transplantation, head trauma, renal and hepatic impairment
  • Monitor CBC with differential count and platelet count daily
Carmustine In combination with Prednisone:
150-200 mg/m2 BSA IV infusion over 1-2 hours every 6 weeks or
75-100 mg/m2 IV infusion over 1-2 hours divided within 2 successive days every 6 weeks
Subsequent doses should be adjusted based on hematologic toxicity 		Adverse Reactions
  • GI effects (nausea/vomiting); Hepatic effects (increased transaminase, alkaline phosphatase and bilirubin levels); CV effects (hypotension, chest pain, tachycardia); Respiratory effects (pulmonary infiltrates and/or fibrosis); Other effects (myelosuppression, renal abnormalities, neuroretinitis, headache, allergic reaction)
Special Instructions
  • Use with caution in patients with bone marrow suppression, pre-existing lung disease or reduced lung function
  • Perform baseline pulmonary function studies
  • Monitor CBC with platelet counts weekly
  • Monitor renal, hepatic and pulmonary function periodically
Cyclophosphamide
 Induction dose: 40-50 mg/kg IV in divided doses over 2-5 days
Maintenance dose:10-15 mg/kg/day IV given every 7-10 days or 3-5 mg/kg/day IV twice weekly
In combination with Bortezomib and Dexamethasone: 300 mg/m2/day PO once weekly on days 1, 8, 15 and 22 of a 28-day cycle 		 Adverse Reactions
  • GI effects (nausea/vomiting, anorexia, mucositis); GU effects (acute hemorrhagic cystitis, urinary fibrosis, renal tubular necrosis); Dermatologic effects (alopecia, rash); Respiratory effects (rhinorrhea, nasal congestion); Other effects (fertility impairment, syndrome of inappropriate antidiuretic hormone secretion [SIADH] may occur with doses >50 mg/kg, leukopenia, headache)
Special Instructions
  • Contraindicated in patients with bladder hemorrhage, bone marrow aplasia, acute infection, drug-/radiation-induced urothelial toxicity, porphyria
  • Use with caution in patients with hepatic/renal impairment
Doxorubicin  In combination with Bortezomib:
30 mg/m2 as 1-hour IV infusion on day 4 of Bortezomib 3-week regimen 		 Adverse Reactions
  • Dermatologic effects (injection site reaction, alopecia, urticaria, rash); GI effects (nausea/vomiting, stomatitis, GI ulceration, diarrhea, loss of appetite); GU effects (urinary frequency, hematuria); Hematologic effects (leukopenia, thrombocytopenia, anemia); CV effects (transient ECG abnormalities, congestive heart failure [CHF]); CNS effects (neuralgia, headache, peripheral sensory neuropathy, insomnia); Other effects (discoloration of body fluids, hyperuricemia, infertility)
  • Potentially fatal: Bone marrow suppression, cardiotoxicity
Special Instructions
  • Contraindicated in patients with cardiac disease, severe myelosuppression secondary to anti-tumor chemo/radiotherapy, history of mediastinum irradiation
  • Use with caution in patients with hepatic and severe renal impairment
  • Monitor CBC and ECG prior to and post-therapy
  • Not to be given as IV bolus/IM/SC
Epirubicin
 Monotherapy: 60-120 mg/m2 IV
Max dose: 135 mg/m2 IV given on day 1 or in divided doses on the first, second, third day every 3-4 weeks
Combination therapy:
Max dose: 120 mg/m2 IV given on the 1st day every 3-4 weeks 
Adverse Reactions
  • CNS effects (changes in sensorium, fever); GI effects (nausea/vomiting, diarrhea, loss of appetite); Dermatologic effects (injection site reaction, alopecia, anaphylaxis, rash); Hematologic effects (leukopenia, thrombocytopenia, anemia); Other effects (menstrual dysfunction, hot flushes)
Special Instructions
  • Avoid in patients with cardiac disease (severe myocardial insufficiency, severe arrhythmias and recent MI) and in patients with baseline neutrophil count 1,500 cells/mm3
  • Use with caution in patients with pre-existing cardiac disease, hepatic and renal dysfunction and in patients who have previously received anthracyclines
  • Do not administer via IM/SC
Melphalan
 400 mcg/kg or 16 mg/m2 IV infusion over 15-20 minutes x 4 doses every 2 weeks
Further doses given every 4 weeks depending on toxicity
High-dose regimen:100-200 mg/m2 IV followed by autologous stem cell rescue which is essential if doses exceed 140 mg/m2, to be given through a central venous catheter
or
150 mcg/kg/day PO in divided doses for 4-7 days or 250 mcg/kg PO 24 hourly x 4 days or 6 mg PO 24 hourly x 2-3 weeks, followed by up to 4 week rest period
Then repeat the course or start maintenance treatment with 1-3 mg or up to 50 mcg/kg PO 24 hourly
 Adverse Reactions
  • Dermatologic effects (rashes, hypersensitivity, skin ulceration, necrosis, alopecia); GI effects (nausea/vomiting, diarrhea, stomatitis); Hematologic effects (hemolytic anemia, bone marrow depression, leukopenia, thrombocytopenia, anemia); Other effects (pulmonary fibrosis, myalgia, flu-like symptoms)
Special Instructions
  • Contraindicated in lactating women
  • Use with caution in pregnancy, in patients with renal impairment, and in those who have just received radiotherapy or cytotoxic agents
  • Monitor blood counts
Vincristine
 1.4 mg/m2 IV on day 1 of a 4-week treatment cycle   Adverse Reactions
  • Dermatologic effect (alopecia); CV effects (orthostatic hypotension or hypertension); CNS effects (depression, headache, insomnia, fever); GI effects (anorexia, bloating, paralytic ileus, constipation)
Special Instructions
  • Use with caution in patients with hepatic impairment, leukopenia, acute uric acid nephropathy, and pre-existing neuromuscular disease

Targeted Cancer Therapy


Drug Dosage Remarks
Monoclonal Antibodies
Belantamab mafodotin 2.5 mg/kg IV infusion over 30 minutes every 3 weeks until disease progression or unacceptable toxicity Adverse Reactions
  • Metabolic effects (decreased serum albumin, increased serum glucose, serum creatinine and serum AST); Hematologic effects (thrombocytopenia, lymphocytopenia); Other effect (decreased visual acuity)
Special Instructions
  • Perform CBC at baseline and throughout treatment as clinically indicated
  • Perform ophthalmologic exams at baseline, prior to each dose and promptly for worsening symptoms
  • Monitor infusion-related reactions
Ciltacabtagene autoleucel
 0.5-1.0 × 106 CAR-positive viable T cells per kg body wt IV infusion
Max dose: 1 × 108 CAR-positive T cells per single-dose IV infusion

Adverse Reactions

  • Respiratory effects (upper respiratory tract infection [URTI], dyspnea, cough); GI effects (diarrhea, constipation, nausea/vomiting, decreased appetite); CNS effects (headache, encephalopathy, dizziness, fatigue, chills); CV effects (hypotension, tachycardia); Hematologic effects (coagulopathy, thrombocytopenia, neutropenia, anemia, hypogammaglobulinemia); Metabolic effects (aminotransferase elevation, hypoalbuminemia); Other effects (pyrexia, cytokine release syndrome, edema, viral infections, musculoskeletal pain, infections-pathogen unspecified)

Special Instructions

  • For autologous use only
  • Monitor patient's blood counts prior to and after infusion, signs and symptoms of infection, hypersensitivity reactions during infusion
  • Advise patients to refrain from driving and engaging in hazardous occupations or activities, such as operating heavy or potentially dangerous machinery, for at least 8 weeks after receiving Ciltacabtagene autoleucel and in the event of any new onset of neurologic toxicities
Daratumumab  Monotherapy and in combination with Lenalidomide or Pomalidomide and low-dose Dexamethasone:
16 mg/kg IV infusion as 4-week cycle regimen
Week 1-8: Weekly (total of 8 doses)
Week 9-24: Every 2 weeks, first dose to be given at week 9 (total of 8 doses)
Week 25 until disease progression: Every 4 weeks, first dose to be given at week 25
In combination with Bortezomib and Dexamethasone:
16 mg/kg IV infusion as 3-week cycle regimen
Week 1-9: Weekly (total of 9 doses)
Week 10-24: Every 3 weeks, first dose to be given at week 10 (total of 5 doses)
Week 25 until disease progression: Every 4 weeks, first dose to be given at week 25
In combination with Carfilzomib and Dexamethasone:
Week 1: 8 mg/kg IV infusion on days 1 and 2 (total of 2 doses)
Week 2-8: 16 mg/kg IV infusion weekly (total of 7 doses)
Week 9-24: 16 mg/kg IV infusion every 2 weeks (total of 8 doses)
Week 25 until disease progression:
16 mg/kg IV infusion every 4 weeks
In combination with Bortezomib, Melphalan and Prednisone: 16 mg/kg IV infusion as 6-week cycle regimen
Week 1-6: Weekly (total of 6 doses)
Week 7-54: Every 3 weeks, first dose to be given at week 7 (total of 16 doses)
Week 55 until disease progression: Every 4 weeks, first dose to be given at week 55
In combination with Bortezomib, Thalidomide and Dexamethasone:
16 mg/kg IV infusion as 4-week cycle regimen
Induction phase:
Week 1-8: Weekly (total of 8 doses)
Week 9-16: Every 2 weeks, first dose to be given at week 9 (total of 4 doses)
Consolidation phase:
Week 1-8: Every 2 weeks, first dose to be given at week 1 upon re-initiation of treatment following AHCT (total of 4 doses)
Subcutaneous dose:
1,800 mg with Hyaluronidase-fihj 30,000 units SC into the abdomen approximately 3-5 minutes based on recommended schedule 

Adverse Reactions

  • Respiratory effects (URTI, pneumonia, nasopharyngitis, cough, dyspnea); Hematologic effects (anemia, neutropenia, thrombocytopenia); GI effects (nausea/vomiting, diarrhea, constipation, decreased appetite); Musculoskeletal effects (back and musculoskeletal chest pain, arthralgia, pain in extremity); CNS effects (peripheral sensory neuropathy, headache, paresthesia, fatigue); Other effects (pyrexia, infusion-related reaction)

Special Instructions

  • Pre-medicate with antihistamine, antipyretics and corticosteroids
  • Periodically monitor CBC during treatment
Elotuzumab In combination with Lenalidomide and Dexamethasone:
10 mg/kg IV infusion weekly x 2 cycles, then every 2 weeks thereafter until disease progression or unacceptable toxicity
In combination with Pomalidomide and Dexamethasone:
10 mg/kg IV infusion weekly x 2 cycles, then 20 mg/kg IV infusion every 4 weeks thereafter until disease progression or unacceptable toxicity
In combination with Bortezomib and Dexamethasone:
10 mg/kg IV infusion weekly x 2 cycles, then on days 1 and 11 during cycles 3-8 then every 2 weeks thereafter until disease progression or unacceptable toxicity

Adverse Reactions

  • With Lenalidomide and Dexamethasone: GI effects (diarrhea, constipation); Respiratory effects (URTI, cough, nasopharyngitis, pneumonia); Other effects (fatigue, pyrexia, peripheral neuropathy)
  • With Pomalidomide and Dexamethasone: Constipation, hyperglycemia

Special Instructions

  • Pre-medicate with an antihistamine, antipyretic and corticosteroidsMonitor LFTs, temperature and for other signs of infection, and signs/symptoms of second primary malignancies
  • Do not administer as IV bolus
Elranatamab
 Day 1: 12 mg SC
Day 4: 32 mg SC
Day 8: 76 mg SC
Maintenance dose: 76 mg SC weekly 1 week after first treatment dose for 24 weeks or
76 mg SC at week 25 and 2 weekly thereafter
 Adverse Reactions
  • Hematologic effects (cytokine release syndrome, decreased lymphocytes, neutrophils, hemoglobin, WBC and platelets); GI effects (diarrhea, nausea, decreased appetite); Respiratory effects (URTI, cough, pneumonia); Other effects (fatigue, injection site reaction, musculoskeletal pain, rash, pyrexia)
Special Instructions
  • Administer pre-treatment medications as recommended
  • Patients should be hospitalized for 48 hours after administration of the first step-up dose, and for 24 hours after administration of the second step-up dose
  • Monitor CBC, liver enzymes and bilirubin at baseline and during treatment, and for signs and symptoms of infection
Idecabtagene vicleucel 300-510 × 106 CAR-positive T cells IV infusion

Adverse Reactions

  • Respiratory effect (URTI); GI effects (diarrhea, nausea, decreased appetite); Hematologic effects (neutropenia, leukopenia, anemia, thrombocytopenia, lymphopenia, hypogammaglobulinemia); CNS effects (headache, encephalopathy, fatigue); Other effects (cytokine release syndrome, unspecified infections, viral infections, musculoskeletal pain, edema, pyrexia)

Special Instructions

  • For autologous use only
  • Monitor blood counts, for signs/symptoms of infection, and signs/symptoms of second primary malignancies
Isatuximab-irfc In combination with Carfilzomib and Dexamethasone:
10 mg/kg IV weekly x 4 weeks followed by every 2 weeks until disease progression or unacceptable toxicity
In combination with Pomalidomide and Dexamethasone:
10 mg/kg IV weekly x 4 weeks followed by every 2 weeks until disease progression or unacceptable toxicity

Adverse Reactions

  • Respiratory effects (pneumonia, URTI); Hematologic effects (anemia, neutropenia, thrombocytopenia, lymphopenia); GI effects (nausea/vomiting, diarrhea); Other effect (infusion-related reactions)

Special Instructions

  • Permanently discontinue for grade ≥3 infusion-related reactions
  • Monitor CBC periodically during treatment, for signs of infection in patients with neutropenia, for development of second primary malignancies
Talquetamab  Weekly dosing:
Day 1: 0.01 mg/kg SC
Day 4: 0.06 mg/kg SC
Day 7: 0.4 mg/kg SC
Maintenance dose: 0.4 mg/kg SC weekly (minimum of 6-day interval)
Bi-weekly dosing:
Day 1: 0.01 mg/kg SC
Day 4: 0.06 mg/kg SC
Day 7: 0.4 mg/kg SC
Day 10: 0.8 mg/kg SC
Maintenance dose: 0.8 mg/kg SC every 2 weeks (minimum of 12-day interval)  		 Adverse Reactions
  • Hematologic effects (cytokine release syndrome, hypogammaglobulinaemia, anemia, neutropenia, thrombocytopenia, lymphopenia, sepsis); GI effects (dysgeusia, dry mouth, dysphagia, diarrhea, decreased appetite); Respiratory effects (URTI, cough, coronavirus disease 2019); Dermatologic effects (nail disorder, skin disorder, rash, xerosis, pruritus); Other effects (musculoskeletal pain, fatigue, decreased weight, pyrexia, pain, headache, bacterial/viral infection, immune effector cell-associated neurotoxicity syndrome)
Special Instructions
  • Administer pre-treatment medications as recommended
  • Patients should be hospitalized for 48 hours after administration of the first step-up dose, and for 24 hours after administration of the second step-up dose
  • Monitor CBC, liver enzymes and bilirubin at baseline and during treatment, and for signs and symptoms of infection
Teclistamab-cqyv Day 1: 0.06 mg/kg SC
Day 4: 0.3 mg/kg SC
Day 7: 1.5 mg/kg SC
Maintenance dose: 1.5 mg/kg SC weekly until disease progression or unacceptable toxicity or 1.5 mg/kg SC every 2 weeks until disease progression or unacceptable toxicity in patients who have achieved and maintained CR or better for ≥6 months  		 Adverse Reactions
  • Respiratory effects (URTI, pneumonia); Hematologic effects (lymphopenia, neutropenia, leukopenia, anemia, thrombocytopenia); GI effects (nausea/vomiting, diarrhea); Other effects (pyrexia, cytokine release syndrome, fatigue)
Special Instructions
  • Step-up doses may be given between 2-7 days after last dose
  • Monitor CBC periodically during treatment, for signs and symptoms of infection
Other Antineoplastic Agents
Bortezomib Monotherapy:
Initial dose: 1.3 mg/m2/dose given as 3-5 second IV bolus or SC twice weekly x 2 weeks followed by a 10-day rest period
Maintenance dose: 1.3 mg/m2/dose given as 3-5 second IV bolus weekly x 4 weeks followed by a 13-day rest period
Combination therapy with Doxorubicin or Dexamethasone: 1.3 mg/m2 IV bolus over 3-5 seconds or SC on days 1, 4, 8 and 11 every 3 weeks
Combination therapy with Melphalan and Prednisone: 1.3 mg/m2 IV bolus over 3-5 seconds or SC 2x weekly on days 1, 4, 8, 11, 22, 25, 29 and 32 during cycles 1-4 then weekly on days 1, 8, 22 and 29 from cycles 5-9 of a 6-week treatment regimen
Combination therapy with Dexamethasone/Thalidomide: 1.3 mg/m2 IV bolus over 3-5 seconds or SC on days 1, 4, 8 and 11 every 4 weeks
Combination therapy with Lenalidomide and Dexamethasone: 1.3 mg/m2 IV bolus over 3-5 seconds or SC on days 1, 4, 8 and 11 every 3 weeks
Combination therapy with Cyclophosphamide and Dexamethasone: 1.5 mg/m2 IV bolus over 3-5 seconds or SC on days 1, 8, 15 and 22 every 4 weeks 

Adverse Reactions

  • Hematologic effects (thrombocytopenia, anemia, neutropenia); CNS effects (peripheral neuropathy, headache, paresthesia); CV effects (hypotension, development/exacerbation of CHF, new onset of decreased LV ejection fraction); GI effects (acute liver failure, increased liver enzymes, hyperbilirubinemia, hepatitis, nausea/vomiting, decreased appetite); Respiratory effects (acute diffuse infiltrative pulmonary disease, acute respiratory distress syndrome); Other effects (asthenia, pyrexia, anorexia)

Special Instructions

  • May re-initiate treatment at 25% reduced dose once toxicity resolves (1.3 mg/m2/dose reduced to 1 mg/m2/dose; 1 mg/m2/dose reduced to 0.7 mg/m2/dose)
  • Use with caution in patients with tumor lysis syndrome, moderate or severe hepatic impairment, pulmonary disorders, cardiac disease
  • Monitor CBC and platelet counts regularly during treatment
Carfilzomib Monotherapy:
Initial dose: 20 mg/m2 IV as a 10-minute infusion on 2 consecutive days in cycle 1 on days 1 and 2, each week for 3 weeks followed by a 12-day rest period
If tolerated, increase dose to 27 mg/m2 on day 8 of cycle 1. From cycle 13, omit days 8 and 9
In combination with Lenalidomide and Dexamethasone:
Starting dose: 20 mg/m2 IV as 10-minute infusion in cycle 1 on days 1 and 2 each week for 3 weeks (days 1, 2, 8, 9, 15 and 16), followed by a 12-day rest period (days 17-28) If tolerated, increase dose to 27 mg/m2 on day 8 of cycle 1. From cycle 13, omit days 8 and 9
In combination with Dexamethasone:
Starting dose: 20 mg/m2 IV as a 30-minute infusion on 2 consecutive days each week for 3 weeks (days 1, 2, 8, 9, 15 and 16) followed by a 12-day rest period (days 17-28)
If tolerated, increase dose to 56 mg/m2 IV infusion on day 8 of cycle 1
In combination with Daratumumab and Dexamethasone:
Starting dose: 20 mg/m2 IV as a 30-minute infusion on 2 consecutive days each week for 3 weeks (days 1, 2, 8, 9, 15 and 16) followed by a 12-day rest period (days 17-28)
If tolerated, increase dose to 56 mg/m2 IV infusion on day 8 of cycle 1 or 20 mg/m2 IV as a 30-minute IV infusion on day 1 of cycle 1 once weekly
If tolerated, increase to 70 mg/m2 from day 8 of cycle 1 and thereafter

Adverse Reactions

  • Respiratory effects (URTI, pneumonia, nasopharyngitis, cough); Hematologic effects (anemia, neutropenia, thrombocytopenia); GI effects (nausea, diarrhea, constipation, decreased appetite); Musculoskeletal effects (back and musculoskeletal chest pain, arthralgia, pain in extremity); Other effects (fatigue, pyrexia, infusion-related reaction)

Special Instructions

  • Ensure adequate hydration
  • Use with caution in patients who require mental alertness (ie driving, machine operation)
  • Periodically monitor CBC during treatment; conduct indirect Coombs' test
Ixazomib citrate  In combination with Lenalidomide and Dexamethasone:
Starting dose: 4 mg PO weekly on days 1, 8, and 15 of a 28-day treatment cycle
In combination with Dexamethasone: 5.5 mg PO weekly on days 1, 8 and 15 of a 28-day treatment cycle until disease progression or unacceptable toxicity 		 Adverse Reactions
  • Hematologic effects (thrombocytopenia, neutropenia); GI effects (nausea/vomiting, diarrhea, constipation); Other effects (peripheral edema, URTI, rash, back pain, peripheral neuropathy)
Special Instructions
  • Should be taken on an empty stomach
  • Use with caution in patients with thrombocytopenia, GI toxicities, peripheral neuropathy, peripheral edema, rash, hepatotoxicity, posterior reversible encephalopathy syndrome, moderate-severe hepatic impairment, severe renal impairment or end-stage renal disease
  • Monitor platelet counts at least monthly during treatment; symptoms of peripheral neuropathy; hepatic enzymes
  • Avoid concomitant use with strong CYP34 inducers (eg Carbamazepine, Phenytoin, Rifampicin and St John's Wort)
  • Use with caution in patients who require mental alertness (ie driving, machine operation)
Panobinostat  In combination with Bortezomib and Dexamethasone:
20 mg PO on days 1, 3 and 5 in week 1 and 2 of a 21-day cycle x 8-16 cycles
Adverse Reactions
  • Fatal effects: Severe diarrhea, severe and fatal cardiac toxicities (severe arrhythmias, ECG changes)
  • Hematologic effects (thrombocytopenia, lymphopenia, leukopenia, neutropenia, anemia); GI effects (diarrhea, nausea/vomiting, decreased appetite); Metabolic effects (hypophosphatemia, increased creatinine, hypokalemia, hyponatremia); Other effects (fatigue, peripheral edema, pyrexia)
Special Instructions
  • Should be swallowed whole with a cup of water
  • Use with caution in patients at risk for pulmonary or gastrointestinal hemorrhage, with hepatic impairment
  • Monitor hepatic enzymes, CBC, platelet count
  • Advise patients to avoid star fruit, pomegranate or pomegranate juice, and grapefruit or grapefruit juice
Selinexor  In combination with Bortezomib and Dexamethasone:
100 mg PO on day 1 of each week until disease progression or unacceptable toxicity
In combination with Dexamethasone: 80 mg PO on days 1 and 3 of each week until disease progression or unacceptable toxicity
Adverse Reactions
  • Hematologic effects (thrombocytopenia, anemia, leukopenia, neutropenia); GI effects (diarrhea, nausea/vomiting, constipation, decreased appetite); Other effects (fatigue, decreased weight, dyspnea, hyponatremia, URTI)
Special Instructions
  • Use with caution in patients at risk for bleeding, infection, hyponatremia and neurologic and gastrointestinal toxicities
  • Monitor platelet count, neutrophil count and serum Na levels at baseline, during treatment and as clinically indicated

Agents Affecting Bone Metabolism

Supportive Therapy

Drug Dosage Remarks
Denosumab
Prevention of skeletal-related events in multiple myeloma:
120 mg SC in the upper thigh, upper arm, or abdomen every 4 weeks
 Adverse Reactions
  • Dermatologic effects (alopecia, hyperhidrosis, rash); Musculoskeletal effects (musculoskeletal pain, osteonecrosis of the jaw); Metabolic effects (hypocalcemia, hypophosphatemia); GI effects (nausea, diarrhea); Hematologic effects (anemia, thrombocytopenia); Respiratory effects (URTI, dyspnea, pneumonia); Other effects (new primary malignancy, tooth extraction, peripheral edema)
Special Instructions
  • Calcium and vitamin D supplementation is recommended
  • Contraindicated in patients with hypocalcemia
  • Avoid abrupt discontinuation
  • Use with caution in patients with severe renal impairment
  • Monitor calcium levels during therapy and for signs of osteonecrosis of the jaw, atypical femoral fracture
Pamidronate
(Disodium pamidronate) 		Not to exceed 90 mg IV infusion in 500 mL over 4 hours every 4 weeks

Adverse Reactions
  • Metabolic effects (hypocalcemia, hypophosphatemia, hypokalemia, hypomagnesemia, increased serum creatinine); Hematologic effects (lymphocytopenia, thrombocytopenia, anemia); CNS effects (headache, insomnia, somnolence); GI effects (anorexia, gastritis, nausea/vomiting, constipation, abdominal pain); Injection site reactions (redness, swelling, induration, phlebitis, thrombophlebitis at infusion site); Musculoskeletal effects (myalgia, transient bone pain, arthralgia, generalized and skeletal pain); Other effects (mild fever, hypertension, conjunctivitis, influenza-like symptoms)
Special Instructions
  • Use with caution in patients with hypercalcemia, post-thyroid surgery, cardiac disease, pre-existing or at risk for renal impairment, mild-moderate renal impairment, precipitated convulsions, jaw osteonecrosis, musculoskeletal pain
  • Use with caution in patients who require mental alertness (ie driving, machine operation)
Zoledronic acid
4 mg IV as single dose over not <15 minutes every 3-4 weeks 		Adverse Reactions
  • Musculoskeletal effects (increased bone pain from mineralization defect, back pain, myalgia); GI effects (diarrhea, nausea/vomiting); CNS effects (headache, dizziness, depression, fatigue); Other effects (dyspnea, eye pain, hypocalcemia, fever)
Special Instructions
  • Avoid in patients with severe renal impairment or acute renal impairment
  • Use with caution in patients with mild-moderate renal impairment, osteonecrosis of the jaw, atypical fractures of the femur, musculoskeletal pain, asthma, severe hepatic impairment, patient who requires mental alertness (ie driving, machine operation)

Antivirals

Supportive Therapy
Drug Dosage Remarks
Interferon alfa-2b
(Interferon α-2b, Recombinant human interferon α-2b)
Induction therapy:
3-5 MIU/m2 SC 3x weekly
Maintenance dose:
3-5 MIU/m2 SC 3x weekly
Adverse Reactions
  • Metabolic effects (hypertriglyceridemia, thyroid abnormalities, hyperglycemia); CNS effects (confusion, coma, seizures, depression, anorexia, fatigue); Dermatologic effects (injection site erythema and pain, alopecia, psoriasiform rash); Other effects (flu-like symptoms, CV problems, hypersensitivity reactions, nausea, nephrotoxicity, myelosuppression, lethargy, ocular side effects)
  • Potentially fatal: Hepatotoxicity, pulmonary infiltrates, pneumonitis and pneumonia, autoimmune diseases
Special Instructions
  • Contraindicated in patients with hepatic decompensation, autoimmune hepatitis or a history of autoimmune disease, immunosuppressed transplant recipients
  • Use with caution in patients with pulmonary disease, DM prone to ketoacidosis, coagulation disorders, severe myelosuppression, history of MI and/or arrhythmic disorders, pre-existing/history of psychiatric disorder, particularly depression, poorly controlled thyroid abnormalities, pre-existing psoriasis

Haematopoietic Agents

Supportive Therapy

Drug Dosage Remarks
Epoetin α (Recombinant human erythropoietin, Epoetin alfa)
Chemotherapy-induced anemia:
Initial dose:
150 IU/kg IV/SC injection 3x/week or 450 IU/kg IV/SC injection weekly
Adjust dose to maintain Hgb concentration between 10 g/dL-12 g/dL
Max dose: 40 mg/day
 Adverse Reactions
  • CV effects (dose-dependent BP increase or aggravation of existing hypertension, venous/arterial thromboses); GI effects (diarrhea, nausea/vomiting); Musculoskeletal effects (arthralgia, myalgia, bone pain, pain in extremity, peripheral edema); Other effects (pyrexia, headache, cough, rash, influenza-like illness, injection site reaction)
Special Instructions
  • If Hgb increases by >2 g/dL/month or if Hgb >12 g/dL, reduce dose by 25-50%
  • If Hgb exceeds 13 g/dL, discontinue therapy until it falls below 12 g/dL
  • Contraindicated in patients with uncontrolled hypertension, severe coronary, peripheral arterial, carotid or cerebral vascular disease, including patients with recent MI or cerebral vascular accident, history of pure red cell aplasia after treatment with any erythropoietin, surgical procedure where adequate antithrombotic prophylaxis was not received
  • Use with caution in patients with untreated, inadequately treated or poorly controlled hypertension, epilepsy, medical conditions associated with increased risk for seizures, chronic liver failure, porphyria, increased risk of thrombotic vascular events, history of hypertensive crisis with encephalopathy and seizures, sudden stabbing migraine-like headaches, cerebrovascular accident
  • Monitor blood pressure closely and Hgb levels
Epoetin β (Epoetin beta) Erythropoietin deficiency related-anemia in patients with multiple myeloma:
1 SC injection/week or in divided doses 3-7x/week
Recommended initial dose: 450 IU/kg/week SC
May increase dose to 900 IU/kg SC given in divided doses 2-7x/week if Hgb did not increase by at least 1 g/dL
Max dose: Should not exceed 900 IU/kg/week

 Adverse Reactions
  • CV effects (increased BP, aggravation of existing hypertension); Dermatologic effects (rash, pruritus, urticaria, injection site reactions, anaphylactoid reactions); Other effects (headache, increased platelet count)
Special Instructions
  • Contraindicated in patients with poorly controlled hypertension, unstable angina pectoris, history of MI or stroke a month prior to treatment, increased risk for deep vein thrombosis
  • Use with caution in patients with refractory anemia with excess blasts in transformation, thrombocytosis, epilepsy, chronic liver failure, folic acid and vitamin B12 deficiencies, severe forms of phenylketonuria, renal failure, history of anti-erythropoietin antibodies and pure red cell aplasia development under treatment with another erythropoietic substance
  • Discontinue treatment if Hgb does not increase by at least 1 g/dL after 8 weeks of therapy
  • Therapy should only be reintroduced if erythropoietin deficiency is the most likely cause of the anemia
  • Monitor platelet count regularly during the 1st 8 weeks of therapy; serum K and phosphate levels regularly
Plerixafor
In combination with G-CSF to enhance mobilization of hematopoietic stem cells to the peripheral blood for collection and subsequent AHCT in patients with multiple myeloma whose cells mobilize poorly: 0.24 mg/kg/day SC 6-11 hours prior to initiation of apheresis following 4 days of pretreatment with G-CSF
Max dose: 40 mg/day 		Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, dyspepsia, abdominal pain, abdominal distention, dry mouth, constipation, stomach discomfort, oral hypoesthesia, flatulence); Dermatologic effects (injection site reactions, erythema, hyperhidrosis); Musculoskeletal effects (arthralgia, musculoskeletal pain); CNS effects (insomnia, headache, dizziness, fatigue); Other effect (malaise)
Special Instructions
  • Use with caution in patients with peripheral blood neutrophil counts >50,000 cells/μL, renal impairment or CrCl ≤50 mL/min, risk of systemic and vasovagal reaction, elderly
  • Monitor WBC and platelet count

Vaccines, Antisera & Immunologicals

Supportive Therapy
Drug Dosage Remarks
Human immunoglobulin
(Human Ig, Intravenous immunoglobulin, IVIg)
Replacement therapy:
0.2-0.4 g/kg IV infusion at an initial rate of 1 mL/kg/hr every 3-4 weeks
Adverse Reactions
  • CNS effects (fever, chills, dizziness, anxiety, headache); CV effects (chest pain, hypotension, flushing, pallor, tachycardia, thromboembolism); Dermatologic effects (eczema, urticaria); GI effects (nausea/vomiting, abdominal pain); Hematologic effects (hemolytic anemia, transient neutropenia); Other effects (acute renal failure, conjunctivitis, aseptic meningitis syndrome, pulmonary embolism)
Special Instructions
  • Contraindicated in patients with hypersensitivity to immune globulin and blood products, with IgA deficiency
  • Use with caution in patients with renal disease, DM, volume depletion, sepsis, paraproteinuria, history of CV disease or thrombotic episodes

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women and non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information. 

Related MIMS Drugs