Protocols - Hemorio

RISK STRATIFICATION
High Risk
conventional cytogenetics - del 13;
FISH - t( 4;14 ); t ( 14;16 ), del p53 (17p13)
Standard Risk
when the changes above mentioned are not present
TREATMENT
Treatment indication – Only subjects with symptomatic Multiple Myeloma.
Subjects eligible for the transplant: subjects up to 70 years old
Exclusion criteria for the transplant: >70 years old, PS >2, severe organic dysfunction.
Eligible for TCTH: send to the transplant outpatient clinic and in parallel start the treatment:
Dexamethasone / Thalidomide – Repeat every 4 weeks, a minimum of 4 cycles until the TCTH is
scheduled
Thalidomide 100 to 200mg/day VO daily
Dexamethasone 40mg VO D1-4, D 9-12, D 17-20 on the odd cycles
D1-4 on the even cycles
Women with a child-bearing potential: do not use thalidomide
Prophylaxis of deep venous thrombosis: AAS 100mg
Prophylaxis of HDA: omeprazole 20mg VO/day
Not eligible for TCTH: cycles every 4-6 weeks until the plateau.
- Melphalan 4mg/m 2 /day VO 7 days
- Prednisone 40mg/m 2 /day VO 7 days
- Thalidomide 100mg/day VO continuous usage
MAINTENANCE
Thalidomide 50-100mg/day until there is a progression of the disease
FOLLOW-UP
Monthly before each treatment cycle: Hemogram, Biochemistry with evaluation of the glycemia, renal
function, calcium, total and fractioned proteins.
At least every 3 months: Ig Dosage
After the normalization of the Ig dosage, ask for an Immunofixation in the blood and urine, in order to
prove the disappearance of the monoclonal peak
Annually: bone inventory
COMPLICATIONS
Anemia: Usage of Erythropoietin 8000 IU SC 3 times a week
Lithic injuries: Bisphosphonates - Pamidronate 90 mg EV every 28 days for 2 years. It can be done on the
third year every 3 months.
Renal Failure: Dialysis if necessary. Follow-up by nephrology.
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