I have a 51 year old I’m working up for myeloma. Had all crab criteria Hb 9, ca 12.5, gfr 40’s. His PET just returned with 8x5cm expansile lytic mass involving 4th rib along with diffuse lytic lesions. I have him scheduled for a marrow soon. Just want to confirm I don’t need to biopsy the mass since it’s like systemic disease and not plasmacytoma right? I plan to do Dara-RVD induction given aggressive presentation. I’ve gotten mixed opinions on this. Do you use quad for high risk or for all? He is transplant eligible.
If the marrow confirmed myeloma, then the expansile lytic mass does not need to be biopsied as this is merely a sequelae of the disease. In the Griffin study Dara-Rvd was compared with RVD. although the quad did better overall, the high-risk patients did not do better with the quad over the triplet. I typically use KRD for younger high-risk patients, but as it may take time to get the fish results back you could start dara-rvd once the biopsy confirms the diagnosis. Dara-RVd is what most people are using now for younger transplant eligible anyway
