Insufficient Information to Provide Safe Recommendation
I cannot provide a specific medication recommendation for this patient because the question contains critical missing information that makes it impossible to determine the appropriate next therapy.
Critical Missing Information
The current medication is unidentifiable. The question states the patient is on "investigate 10 mg," which does not correspond to any known medication name in standard medical practice or the provided evidence 1. Without knowing what medication has already failed, I cannot recommend an appropriate next-line therapy.
What Information Is Needed
To provide a safe and evidence-based recommendation, I require:
The actual diagnosis - The evidence provided covers multiple myeloma 2, chronic lymphocytic leukemia 2, follicular lymphoma 2, mantle cell lymphoma 2, and peripheral T-cell lymphoma 2. Each has completely different treatment algorithms.
The current medication name - Knowing what "investigate 10 mg" actually refers to is essential, as treatment sequencing depends on prior therapies 2.
Prior treatment history - The number and type of previous therapies determines which regimens are appropriate next 2.
Patient's functional status - For elderly patients in their late 80s, fitness assessment is crucial for treatment selection, as guidelines distinguish between "fit," "vulnerable," and "terminally ill" patients with different treatment goals 2.
Clinical Approach
Before prescribing any medication to an elderly patient, calculate creatinine clearance using the Cockcroft-Gault formula 3, as serum creatinine alone underestimates renal dysfunction in elderly patients with reduced muscle mass 4, 5, 3.
Clarify the diagnosis and current medication with the patient's medical records or prior treating physician before making any treatment changes 1, 6.