Because of his high-risk cytogenetics and age, this patient is likely to experience multiple relapses. In some other circumstances, BLd may be tried again because the relapse has occurred longer than 6 months after the initial therapy and maintenance. BLd was associated with a good response as first-line therapy and, in theory, may induce remission again.
Carfilzomib is an active combination, but it is associated with significant cardiovascular, renal, and ventricular thromboembolic complications.
Because of the patient's considerable exposure to lenalidomide during maintenance, the best salvage option at this time is a combination of the anti-CD38 antibody daratumumab plus bortezomib and dexamethasone. In 2020, this combination was approved only as second-line therapy by the Pharmaceutical Benefits Advisory Committee and was recommended for Pharmaceutical Benefits Scheme reimbursement.
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Cite this: Maria-Victoria Mateos, Simon J. Harrison. Skill Checkup: An Elderly Man With Leg Pain and Weakness - Medscape - Apr 04, 2022.