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Transplant-Eligible Myeloma — RACP Adult Medicine MCQ

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ModerateHaematologyTransplant-Eligible MyelomaRACP Adult Medicine

A 55-year-old fit man is diagnosed with transplant-eligible multiple myeloma (IgG kappa, ISS stage II, standard-risk cytogenetics). He has good performance status and normal renal function. What is the most appropriate first-line induction regimen?

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Correct answer: A — Daratumumab/VRd (D-VRd)

For transplant-eligible NDMM, daratumumab plus VRd (D-VRd) is now the preferred first-line regimen per NCCN 2025 (PERSEUS trial: D-VRd significantly improved PFS over VRd alone with sustained MRD negativity rates of 64.8% at 10⁻⁶). Quadruplet therapy has become the new standard of care, displacing triplet VRd to 'other recommended.' After 4-6 cycles of induction, proceed to ASCT consolidation then lenalidomide maintenance.

Reference: NCCN – 2025 – Multiple Myeloma; PERSEUS Trial; ALLG 2024