Suggested dose reductions for toxicity or frailty
| Drug . | Fit . | Intermediate . | Frail . | Frequency . |
|---|---|---|---|---|
| PIs | ||||
| Bortezomib | 1.3 or 1.5 mg/m2 | 1 mg/m2 | 0.7 or 1 mg/m2 | D 1, 8, 15, ±22 q28. For ≤1.3 mg/m2 dose, can also give on D 1, 4, 8, 11 q21. For frail consider 2-wk rest period (eg, D 1, 8, 15, 22 q35). |
| Carfilzomib | 27, 36, 56, or 70 mg/m2 | 20 or 27 mg/m2 | 15 mg/m2 | Start at 20 mg/m2 D 1 and 2 and then escalate to 27, 36, or 56 mg/m2 D 8, 9, 15, 16 q28. The 70-mg/m2 dose is given on D 1, 8, 15 q28. |
| Ixazomib | 4 mg | 3 mg | 2.3 mg | D 1, 8, 15 q28 |
| IMIDs | ||||
| Lenalidomide | 25 mg | 15 mg | 10 mg | Typically D 1-21 q28. For very frail consider every other day or a 2-wk rest period (eg, D 1-21 q35). |
| Pomalidomide | 4 mg | 3 mg | 2 mg | |
| Thalidomide | 100 or 200 mg | 50 or 100 mg | 50 mg | Daily. For frail consider every other day. |
| Alkylating agents | ||||
| Cyclophosphamide | 300 mg/m2 | 150 or 225 mg/m2 | 75 or 150 mg/m2 | D 1, 8, 15, ±22 q28 |
| Bendamustine | 90 or 100 mg/m2 | 70, 75, or 80 mg/m2 | 25, 50, or 60 mg/m2 | D 1 and 2 q28 |
| Melphalan | 0.25 mg/kg | 0.18 mg/kg | 0.13 mg/kg | D 1-4 every 4-6 wk |
| Antibodies | ||||
| Daratumumab | 16 mg/kg | No adjustment | No adjustment | With IMID: weekly for 8 wk, then every other wk for 16 wk, and then every 4 wk thereafter. Note that dosing with btz is slightly different.33 |
| Elotuzumab | 10 mg/kg | No adjustment | No adjustment | Weekly for 8 wk, then every other wk. With pomalidomide: weekly for 8 wk, then can give at 20 mg/kg every 4 wk. |
| Histone deacetylase inhibitor | ||||
| Panobinostat | 20 mg | 15 mg | 10 mg | With btz: D 1, 3, 5, 8, 10, 12 q21. With len: D 1, 3, 5, 15, 17, 19 q28. |
| Drug . | Fit . | Intermediate . | Frail . | Frequency . |
|---|---|---|---|---|
| PIs | ||||
| Bortezomib | 1.3 or 1.5 mg/m2 | 1 mg/m2 | 0.7 or 1 mg/m2 | D 1, 8, 15, ±22 q28. For ≤1.3 mg/m2 dose, can also give on D 1, 4, 8, 11 q21. For frail consider 2-wk rest period (eg, D 1, 8, 15, 22 q35). |
| Carfilzomib | 27, 36, 56, or 70 mg/m2 | 20 or 27 mg/m2 | 15 mg/m2 | Start at 20 mg/m2 D 1 and 2 and then escalate to 27, 36, or 56 mg/m2 D 8, 9, 15, 16 q28. The 70-mg/m2 dose is given on D 1, 8, 15 q28. |
| Ixazomib | 4 mg | 3 mg | 2.3 mg | D 1, 8, 15 q28 |
| IMIDs | ||||
| Lenalidomide | 25 mg | 15 mg | 10 mg | Typically D 1-21 q28. For very frail consider every other day or a 2-wk rest period (eg, D 1-21 q35). |
| Pomalidomide | 4 mg | 3 mg | 2 mg | |
| Thalidomide | 100 or 200 mg | 50 or 100 mg | 50 mg | Daily. For frail consider every other day. |
| Alkylating agents | ||||
| Cyclophosphamide | 300 mg/m2 | 150 or 225 mg/m2 | 75 or 150 mg/m2 | D 1, 8, 15, ±22 q28 |
| Bendamustine | 90 or 100 mg/m2 | 70, 75, or 80 mg/m2 | 25, 50, or 60 mg/m2 | D 1 and 2 q28 |
| Melphalan | 0.25 mg/kg | 0.18 mg/kg | 0.13 mg/kg | D 1-4 every 4-6 wk |
| Antibodies | ||||
| Daratumumab | 16 mg/kg | No adjustment | No adjustment | With IMID: weekly for 8 wk, then every other wk for 16 wk, and then every 4 wk thereafter. Note that dosing with btz is slightly different.33 |
| Elotuzumab | 10 mg/kg | No adjustment | No adjustment | Weekly for 8 wk, then every other wk. With pomalidomide: weekly for 8 wk, then can give at 20 mg/kg every 4 wk. |
| Histone deacetylase inhibitor | ||||
| Panobinostat | 20 mg | 15 mg | 10 mg | With btz: D 1, 3, 5, 8, 10, 12 q21. With len: D 1, 3, 5, 15, 17, 19 q28. |
D, days; q, out of every.
Adapted from Larocca et al81 and Wildes and Anderson.4