From the Guidelines
The required frequency and number of MAD+ infusions is not explicitly stated in the provided evidence, but based on the context of multiple myeloma treatment, a common regimen for daratumumab, a key component of MAD+ infusions, is 16 mg/kg intravenously weekly for the first 3 cycles, day 1 of cycles 4 to 8, and then every 4 weeks 1.
Key Considerations
- The evidence provided focuses on the treatment of relapsed multiple myeloma, discussing various regimens including KPd (carfilzomib, pomalidomide, and dexamethasone), DVd (daratumumab, bortezomib, and dexamethasone), and DRd (daratumumab, lenalidomide, and dexamethasone) 1.
- Daratumumab is a crucial component in some of these regimens, and its administration schedule can inform the frequency of MAD+ infusions.
- The CASTOR trial and the POLLUX study demonstrate the efficacy of adding daratumumab to existing therapies, showing improved response rates and progression-free survival in patients with relapsed multiple myeloma 1.
Treatment Regimens
- For patients who relapse while receiving maintenance therapy with lenalidomide, a combination of carfilzomib, pomalidomide, and dexamethasone (KPd) or daratumumab, bortezomib, and dexamethasone (DVd) is recommended 1.
- The IRd regimen (ixazomib, lenalidomide, and dexamethasone) has also shown promise in phase 3 trials, with a 26% reduction in the risk of progression or death due to myeloma compared to placebo Rd 1.
Administration and Monitoring
- The administration of daratumumab and other components of MAD+ infusions should be guided by the patient's response and tolerance, with adjustments made as necessary 1.
- Monitoring for adverse effects, such as infusion-related reactions, neutropenia, and thrombocytopenia, is crucial during treatment with MAD+ infusions 1.
From the Research
MAD+ Infusion Frequency and Number
- The required frequency and number of MAD+ infusions are not directly stated in the provided studies 2, 3, 4, 5, 6.
- However, the studies provide information on the treatment regimens and schedules used in the trials:
- In the study by 2, patients received arsenic trioxide (0.25 mg/kg/day) for 10 days/cycle combined with VCMP or VAD in 30-day cycles.
- In the study by 3, patients received oral melphalan 8 mg/m2 on days 1-4 and oral dexamethasone 40 mg on days 1-4 and days 9-12 every 4 weeks.
- In the study by 4, patients received melphalan (0.1 mg/kg p.o.), arsenic trioxide (0.25 mg/kg i.v.), and ascorbic acid (1 g i.v) on days 1-4 of week 1, and then twice weekly during weeks 2-5.
- In the study by 5, patients received a fixed-dose intravenous infusion of arsenic trioxide daily for a maximum of 60 days.
- In the study by 6, patients received melphalan 200 mg/m2 i.v. over 2 days, ascorbic acid 1000 mg i.v. over 7 days, and arsenic trioxide 0.15 mg/kg i.v. x 7 days or 0.25 mg/kg i.v. x 7 days.
- These studies do not provide a clear answer to the question of the required frequency and number of MAD+ infusions, as they describe different treatment regimens and schedules.