Suggested dose modifications for older adults with myeloma
| Drug . | Dose level 0 . | Dose level − 1* . | Dose level − 2* . |
|---|---|---|---|
| Dexamethasone | 40 mg days 1, 8, 15, 22 every 4 wk | 20 mg days 1, 8, 15, 22 every 4 wk | 10 mg days 1, 8, 15, 22 every 4 wk |
| Or 20 mg on day of and day after bortezomib87 | Or 10 mg on day of and day after bortezomib | ||
| Prednisone | 2 mg/kg days 1-4 of 4- to 6-wk cycle | 1 mg/kg days 1-4 of 4- to 6-wk cycle | 0.3-0.5 mg/kg days 1-4 of 4- to 6-wk cycle |
| Or 60 mg/m2 days 1-4 of 6-wk cycle | Or 30 mg/m2 days 1-4 of 6-wk cycle | Or 10-15 mg/m2 days 1-4 of 4- to 6-wk cycle | |
| Bortezomib | 1.3 mg/m2 days 1, 4, 8, 11 every 3 wk | 1.3 mg/m2 days 1, 8, 15, 22 every 5 wk | 1.0 mg/m2 days 1, 8, 15, 22 every 5 wk |
| Ixazomib | 4 mg days 1, 8, 15 every 4 wk | 3 mg days 1, 8, 15 every 4 wk | 2.3 mg days 1, 8, 15 every 4 wk |
| Carfilzomib | 20 mg/m2 days 1, 2, 8, 9, 15, 16 in cycle 1; 27 mg/m2 in cycle 2+ every 4 wk | 20 mg/m2 days 1, 2, 8, 9, 15, 16 in cycle 1; 27 mg/m2 days 1, 8, 15 in cycle 2+ every 4 wk | 20 mg/m2 days 1, 8, 15 every 4 wk |
| Lenalidomide | 25 mg days 1-21 every 4 wk | 15 mg days 1-21 every 4 wk | 10 mg days 1-21 every 4 wk |
| Pomalidomide | 4 mg days 1-21 every 4 wk | 3 mg days 1-21 every 4 wk | 2 mg days 1-21 every 4 wk |
| Thalidomide | 100-200 mg daily | 50-100 mg daily | 50 mg every other day; 50 mg daily |
| Melphalan | 0.25 mg/kg days 1-4 every 4-6 wk | 0.18 mg/kg days 1-4 every 4-6 wk | 0.13 mg/kg days 1-4 every 4-6 wk |
| Cyclophosphamide | 300 mg/m2 days 1, 8, 15 (±22) every 4 wk | 150 mg/m2 days 1, 8, 15 every 4 wk | 75 mg/m2 days 1, 8, 15 every 4 wk |
| Daratumumab | 16 mg/kg weekly for cycles 1-2 (4-wk cycles), then every other week for cycles 3-6, then every 4 wk | No age- or frailty-related dose modifications | No age- or frailty-related dose modifications |
| Elotuzumab | 10 mg/kg weekly for cycles 1-2 (4-wk cycles), then every other week | No age- or frailty-related dose modifications | No age- or frailty-related dose modifications |
| Drug . | Dose level 0 . | Dose level − 1* . | Dose level − 2* . |
|---|---|---|---|
| Dexamethasone | 40 mg days 1, 8, 15, 22 every 4 wk | 20 mg days 1, 8, 15, 22 every 4 wk | 10 mg days 1, 8, 15, 22 every 4 wk |
| Or 20 mg on day of and day after bortezomib87 | Or 10 mg on day of and day after bortezomib | ||
| Prednisone | 2 mg/kg days 1-4 of 4- to 6-wk cycle | 1 mg/kg days 1-4 of 4- to 6-wk cycle | 0.3-0.5 mg/kg days 1-4 of 4- to 6-wk cycle |
| Or 60 mg/m2 days 1-4 of 6-wk cycle | Or 30 mg/m2 days 1-4 of 6-wk cycle | Or 10-15 mg/m2 days 1-4 of 4- to 6-wk cycle | |
| Bortezomib | 1.3 mg/m2 days 1, 4, 8, 11 every 3 wk | 1.3 mg/m2 days 1, 8, 15, 22 every 5 wk | 1.0 mg/m2 days 1, 8, 15, 22 every 5 wk |
| Ixazomib | 4 mg days 1, 8, 15 every 4 wk | 3 mg days 1, 8, 15 every 4 wk | 2.3 mg days 1, 8, 15 every 4 wk |
| Carfilzomib | 20 mg/m2 days 1, 2, 8, 9, 15, 16 in cycle 1; 27 mg/m2 in cycle 2+ every 4 wk | 20 mg/m2 days 1, 2, 8, 9, 15, 16 in cycle 1; 27 mg/m2 days 1, 8, 15 in cycle 2+ every 4 wk | 20 mg/m2 days 1, 8, 15 every 4 wk |
| Lenalidomide | 25 mg days 1-21 every 4 wk | 15 mg days 1-21 every 4 wk | 10 mg days 1-21 every 4 wk |
| Pomalidomide | 4 mg days 1-21 every 4 wk | 3 mg days 1-21 every 4 wk | 2 mg days 1-21 every 4 wk |
| Thalidomide | 100-200 mg daily | 50-100 mg daily | 50 mg every other day; 50 mg daily |
| Melphalan | 0.25 mg/kg days 1-4 every 4-6 wk | 0.18 mg/kg days 1-4 every 4-6 wk | 0.13 mg/kg days 1-4 every 4-6 wk |
| Cyclophosphamide | 300 mg/m2 days 1, 8, 15 (±22) every 4 wk | 150 mg/m2 days 1, 8, 15 every 4 wk | 75 mg/m2 days 1, 8, 15 every 4 wk |
| Daratumumab | 16 mg/kg weekly for cycles 1-2 (4-wk cycles), then every other week for cycles 3-6, then every 4 wk | No age- or frailty-related dose modifications | No age- or frailty-related dose modifications |
| Elotuzumab | 10 mg/kg weekly for cycles 1-2 (4-wk cycles), then every other week | No age- or frailty-related dose modifications | No age- or frailty-related dose modifications |
Aggregated and adapted from suggested dose modifications based on age, frailty, or prior toxicity.19,28-31
Dose-level selection based on age, frailty measures, or comorbidities has been proposed but has not been prospectively studied.