OpenOnco · Treatment Plan

Treatment plan — Multiple Myeloma

PLAN-MM-STD-001-V1 · v1 · 2026-09-09

Patient

MM-STD-001 · Algorithm: ALGO-MM-1L

DiagnosisMultiple Myeloma

MOH / ICD-10C90.0

ICD-O-39732/3; C42.1

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks

✅ Covered biomarkers (matched in KB)

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
No clinically actionable variants matched in this profile.

⚠️ Not included in plan

Biomarker	Status
BIO-MM-CYTOGENETICS-HR	BIO definition in KB; no ESCAT BMA entry — verify with clinician
BIO-HCV-STATUS	BIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-MM-1L-VRD

Regimen

Bortezomib + Lenalidomide + Dexamethasone (VRd), 4-6 induction cycles

Drugs + NSZU

Bortezomib (DRUG-BORTEZOMIB) 1.3 mg/m² · SC days 1, 8, 15 of each 28-day cycle (weekly schedule for induction) · SC ⚠ NSZU — not for this indication
Lenalidomide (DRUG-LENALIDOMIDE) 25 mg · PO days 1-21 of each 28-day cycle · PO ⚠ NSZU — not for this indication
Dexamethasone (DRUG-DEXAMETHASONE) 40 mg (20 mg if age >75 or frail) · PO days 1, 8, 15, 22 of each 28-day cycle · PO ✓ NSZU covered

Supportive care

SUP-HSV-PROPHYLAXIS, SUP-MM-VTE-PROPHYLAXIS, SUP-MM-BONE-PROTECTION

Hard contraindications

CI-LENALIDOMIDE-PREGNANCY, CI-BORTEZOMIB-SEVERE-NEUROPATHY

Reason

Primary current-line option selected by ALGO-MM-1L at step 3.

Other current-line alternatives (3 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.

Aggressive plan

Indication

IND-MM-1L-DVRD

Regimen

Daratumumab + Bortezomib + Lenalidomide + Dexamethasone (D-VRd), 4-6 induction cycles

Drugs + NSZU

Daratumumab (DRUG-DARATUMUMAB) 1800 mg SC (or 16 mg/kg IV) · weekly cycles 1-2 (days 1, 8, 15, 22), every 2 weeks cycles 3-6 (days 1, 15) · SC ⚠ NSZU — not for this indication
Bortezomib (DRUG-BORTEZOMIB) 1.3 mg/m² · SC days 1, 8, 15 of each 28-day cycle · SC ⚠ NSZU — not for this indication
Lenalidomide (DRUG-LENALIDOMIDE) 25 mg · PO days 1-21 of each 28-day cycle · PO ⚠ NSZU — not for this indication
Dexamethasone (DRUG-DEXAMETHASONE) 40 mg (20 mg if age >75 or frail; given before daratumumab as part of premedication) · PO/IV days 1, 8, 15, 22 of each 28-day cycle · PO ✓ NSZU covered

Supportive care

SUP-HSV-PROPHYLAXIS, SUP-MM-VTE-PROPHYLAXIS, SUP-MM-BONE-PROTECTION, SUP-PJP-PROPHYLAXIS

Hard contraindications

CI-LENALIDOMIDE-PREGNANCY, CI-BORTEZOMIB-SEVERE-NEUROPATHY, CI-HBV-NO-PROPHYLAXIS

Reason

Current-line alternative presented for HCP consideration

Standard plan

Indication

IND-MM-1L-RD

Regimen

Lenalidomide + Dexamethasone continuous (Rd, MAIA control arm — MM 1L transplant-ineligible)

Drugs + NSZU

Lenalidomide (DRUG-LENALIDOMIDE) 25 mg PO daily (10 mg if CrCl 30-60 mL/min) · Days 1-21 of each 28-day cycle; continuous until progression · PO ⚠ NSZU — not for this indication
Dexamethasone (DRUG-DEXAMETHASONE) 40 mg PO weekly (20 mg if age >75 or frail) · Days 1, 8, 15, 22 of each 28-day cycle · PO ✓ NSZU covered

Supportive care

SUP-MM-VTE-PROPHYLAXIS, SUP-MM-BONE-PROTECTION

Hard contraindications

CI-LENALIDOMIDE-PREGNANCY

Reason

Current-line alternative presented for HCP consideration

Aggressive plan

Indication

IND-MM-1L-DARA-RD

Regimen

Daratumumab + Lenalidomide + Dexamethasone (D-Rd, MAIA — MM 1L transplant-ineligible)

Drugs + NSZU

Daratumumab (DRUG-DARATUMUMAB) 1800 mg SC (or 16 mg/kg IV) · Weekly cycles 1-2 (days 1, 8, 15, 22); every 2 weeks cycles 3-6 (days 1, 15); every 4 weeks cycle 7+ (day 1) · SC ⚠ NSZU — not for this indication
Lenalidomide (DRUG-LENALIDOMIDE) 25 mg PO daily (10 mg if CrCl 30-60) · days 1-21 of each 28-day cycle · PO ⚠ NSZU — not for this indication
Dexamethasone (DRUG-DEXAMETHASONE) 40 mg PO/IV weekly (20 mg if age >75 or BMI <18.5 or frail) · days 1, 8, 15, 22 of each 28-day cycle · PO ✓ NSZU covered

Supportive care

SUP-HSV-PROPHYLAXIS, SUP-MM-VTE-PROPHYLAXIS, SUP-MM-BONE-PROTECTION, SUP-PJP-PROPHYLAXIS

Hard contraindications

CI-LENALIDOMIDE-PREGNANCY, CI-HBV-NO-PROPHYLAXIS

Reason

Current-line alternative presented for HCP consideration

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks

ID	Name	Priority	Category	Where to order	Needed for
TEST-BM-ASPIRATE	Bone Marrow Aspirate	Critical	histology	—	all tracks
TEST-BM-TREPHINE	Bone Marrow Trephine	Critical	histology	—	all tracks
TEST-CBC	Complete Blood Count with Differential	Critical	lab	—	all tracks
TEST-CMP	Comprehensive Metabolic Panel	Critical	lab	—	all tracks
TEST-FISH-PANEL	FISH (Fluorescence In Situ Hybridization)	Critical	genomic	CSD Lab ✓ (code TBC)	all tracks
TEST-FREE-LIGHT-CHAINS	Serum Free Light Chains	Critical	lab	—	all tracks
TEST-HBV-SEROLOGY	Hepatitis B Serology Panel (HBsAg, anti-HBc total, anti-HBs)	Critical	lab	—	all tracks
TEST-LDH	Lactate Dehydrogenase	Critical	lab	—	all tracks
TEST-LFT	Liver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin)	Critical	lab	—	all tracks
TEST-SPEP-UPEP	SPEP / UPEP with IFE	Critical	lab	—	all tracks
TEST-WHOLE-BODY-MRI	Whole-Body MRI	Critical	imaging	—	all tracks
TEST-B2-MICROGLOBULIN	Beta-2 Microglobulin	Standard	lab	—	all tracks
TEST-ECHO	Echocardiography	Standard	imaging	—	aggressive
TEST-IMMUNOGLOBULINS	Quantitative Immunoglobulins	Standard	lab	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Multiple myeloma with ISS stage 3 — β2-microglobulin ≥5.5 mg/L — high-risk presentation; supports four-drug daratumumab-anchored 1L and transplant pursuit when feasible; trigger for R-ISS / R2-ISS upgrade with cytogenetics
ISS-3 (β2M ≥5.5) median OS ~29 mo in the original cohort, improved substantially in the daratumumab era. ISS-3 alone is not a sufficient intensification trigger — cytogenetics drive the upgrade to R-ISS (Palumbo 2015) and R2-ISS…
RF-ISS-3SRC-NCCN-MM-2025SRC-ESMO-MM-2023
Multiple myeloma with malignant epidural spinal cord compression: new motor deficit, sensory level, severe back pain with vertebral plasmacytoma / lytic lesion + canal invasion — MM is a leading hematologic cause of MESCC
Per NCCN-MM + ESMO-MM 2023 + EHA-EMN-MM 2025: dexamethasone 40 mg PO/IV bolus, MRI whole spine, urgent RT (8 Gy ×1 or 20-30 Gy fractionated) ± neurosurgical decompression for instability/large mass; bortezomib- based induction begun in…
RF-MM-CORD-COMPRESSIONSRC-NCCN-MM-2025SRC-ESMO-MM-2023SRC-EHA-EMN-MM-2025
Multiple myeloma high-risk cytogenetics: any of t(4;14), t(14;16), t(14;20), del(17p)/TP53 loss, gain or amplification of 1q21 by interphase FISH on CD138-enriched plasma cells
Primary determinant for selecting quadruplet (D-VRd) over triplet (VRd) in transplant-eligible newly-diagnosed MM. R2-ISS captures most of these abnormalities; gain 1q21 is graded by copy count (≥4 copies = amp1q carries higher risk than…
RF-MM-HIGH-RISK-CYTOGENETICSSRC-NCCN-MM-2025SRC-ESMO-MM-2023
Multiple myeloma with hypercalcemia (corrected serum calcium ≥11 mg/dL or symptomatic): part of CRAB criteria; emergency when ≥14 mg/dL or symptomatic (altered mentation, AKI, arrhythmia)
Hypercalcemia is one of CRAB criteria for MM diagnosis; per ESMO-MM 2023 + NCCN-MM: aggressive IV hydration (3-4 L NS/24h), zoledronic acid 4 mg IV (renal-adjusted) or denosumab 120 mg SC; calcitonin 4 IU/kg SC q12h for first 24-48h while…
RF-MM-HYPERCALCEMIASRC-NCCN-MM-2025SRC-ESMO-MM-2023SRC-EHA-EMN-MM-2025
Multiple myeloma with hyperviscosity syndrome — uncommon but classic in IgA-MM (M-spike >5 g/dL, polymerization tendency) or biclonal gammopathy: blurred vision, retinal hemorrhage, mucosal bleeding, neurologic symptoms
Hyperviscosity is much rarer in MM than WM (IgM is intrinsically more viscous than IgG/IgA), but IgA-MM with very high M-spike (>5 g/dL) or biclonal disease can produce it. Per NCCN-MM + ESMO-MM 2023: plasmapheresis 1-2 plasma volumes…
RF-MM-HYPERVISCOSITYSRC-NCCN-MM-2025SRC-ESMO-MM-2023
Aggressive plasma-cell biology indicating need for intensified MM induction: plasma cell leukemia (≥5% circulating plasma cells, or absolute count ≥500/µL), extramedullary disease at diagnosis (soft-tissue plasmacytoma not contiguous with bone), or rapid laboratory progression (≥25% rise in M-protein over 4-8 weeks pre-treatment).
Plasma cell leukemia (PCL) — both primary and secondary forms have inferior PFS/OS on standard VRd; D-VRd or KCd is preferred. EMD at diagnosis (soft-tissue plasmacytoma not extending from bone): ≈30% worse PFS regardless of cytogenetics…
RF-MM-TRANSFORMATION-PROGRESSIONSRC-NCCN-MM-2025SRC-ESMO-MM-2023
Multiple myeloma with R-ISS stage 3 — ISS-3 (β2M ≥5.5) PLUS LDH above ULN PLUS high-risk cytogenetics by FISH (any of t(4;14), t(14;16), del(17p)) — most aggressive presentation; supports four-drug D-VRd induction + ASCT (eligible) or D-Rd intensification (unfit) + maintenance
R-ISS (Palumbo et al., JCO 2015) refined ISS by adding LDH and FISH cytogenetics: R-ISS-3 = ISS-3 + LDH-high + high-risk FISH. R-ISS-3 median OS ~43 mo pre-daratumumab; modern PERSEUS / IsKia / GRIFFIN show D-VRd benefits across risk…
RF-R-ISS-3-HIGH-RISKSRC-NCCN-MM-2025SRC-ESMO-MM-2023

CONTRA-AGGRESSIVE

Hard contraindications to escalation

Lenalidomide is a potent teratogen — pregnancy is an absolute contraindication. Adequate contraception (two methods) and pregnancy testing are mandatory throughout therapy and for ≥4 weeks after discontinuation.CI-LENALIDOMIDE-PREGNANCY
Severe pre-existing peripheral neuropathy is an absolute contraindication to bortezomib — therapy will likely worsen the neuropathy to a disabling and often permanent extent.CI-BORTEZOMIB-SEVERE-NEUROPATHY
Active or latent HBV without antiviral prophylaxis is an absolute contraindication to starting B-cell-depleting / immunomodulatory monoclonal antibody therapy (anti-CD20, anti-CD30 ADC, anti-CD38). Severe HBV reactivation hepatitis risk including fulminant hepatic failure.CI-HBV-NO-PROPHYLAXIS
Lenalidomide is a potent teratogen — pregnancy is an absolute contraindication. Adequate contraception (two methods) and pregnancy testing are mandatory throughout therapy and for ≥4 weeks after discontinuation.CI-LENALIDOMIDE-PREGNANCY
Active or latent HBV without antiviral prophylaxis is an absolute contraindication to starting B-cell-depleting / immunomodulatory monoclonal antibody therapy (anti-CD20, anti-CD30 ADC, anti-CD38). Severe HBV reactivation hepatitis risk including fulminant hepatic failure.CI-HBV-NO-PROPHYLAXIS

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity

Standard plan (IND-MM-1L-VRD)

Do not skip VTE prophylaxis (aspirin 81-100 mg or LMWH) — baseline thrombosis risk on lenalidomide is 10-20%, with prophylaxis falls to 2-5%.
Do not skip HSV/VZV prophylaxis (acyclovir 400 mg BID) during proteasome inhibitor — ~10-15% herpes zoster reactivation without prophylaxis.
Do not use IV bortezomib if SC is available — frequency of severe neuropathy is approximately twice as high with IV administration.
Do not start regimen in women of reproductive age without confirmed two methods of contraception + negative pregnancy test (lenalidomide is a potent teratogen).
Do not prescribe zoledronate without prior dental evaluation — risk of osteonecrosis of the jaw.
Do not skip lenalidomide dose reduction at CrCl 30-60 mL/min (10 mg) — full dose is toxic with renal impairment.

Aggressive plan (IND-MM-1L-DVRD)

Do not prescribe daratumumab without prior red-cell phenotyping (type and screen) — anti-CD38 interferes with direct Coombs and crossmatching.
Do not start without HBV screening + entecavir prophylaxis in HBsAg+ or anti-HBc+ — risk of HBV reactivation significantly elevated on anti-CD38.
Do not confirm D-VRd plan without verified funding pathway — daratumumab is NOT reimbursed via NSZU; the patient must be informed before the plan is announced.
Do not skip VTE prophylaxis (aspirin/LMWH) — IMiD-induced VTE risk is not reduced by adding daratumumab.
Do not skip HSV/VZV prophylaxis — bortezomib + dara combination increases immunosuppression.
Do not skip PJP prophylaxis — anti-CD38 + IMiD + steroid = elevated risk of opportunistic infections.
Do not start in women of reproductive age without two methods of contraception (lenalidomide is teratogenic).

Standard plan (IND-MM-1L-RD)

Do not skip VTE prophylaxis (aspirin 81-100 mg or LMWH) — IMiD-induced VTE risk 10-20% without prophylaxis.
Do not skip HSV/VZV prophylaxis (acyclovir 400 mg BID) — IMiD + steroid elevates herpes zoster reactivation risk.
Do not start in women of reproductive age without two methods of contraception + negative pregnancy test (lenalidomide is teratogenic).
Do not skip lenalidomide dose reduction at CrCl 30-60 mL/min (use 10 mg) — full dose significantly toxic in renal impairment.
Do not prescribe zoledronate without prior dental evaluation — osteonecrosis of the jaw risk.
Do not use IND-MM-1L-RD if daratumumab is funded — aggressive plan (IND-MM-1L-DARA-RD) has superior survival outcomes.

Aggressive plan (IND-MM-1L-DARA-RD)

Do not prescribe daratumumab without prior red-cell phenotyping (type and screen) — anti-CD38 interferes with direct Coombs and crossmatching.
Do not start without HBV screening + entecavir prophylaxis in HBsAg+ or anti-HBc+ — risk of HBV reactivation significantly elevated on anti-CD38.
Do not confirm D-Rd plan without verified funding pathway — daratumumab is NOT reimbursed via NSZU; patient must be informed before the plan is announced.
Do not skip VTE prophylaxis (aspirin/LMWH) — IMiD-induced VTE risk is not reduced by adding daratumumab.
Do not skip HSV/VZV prophylaxis — daratumumab adds to lenalidomide immunosuppression.
Do not skip PJP prophylaxis — anti-CD38 + IMiD + steroid = elevated risk of opportunistic infections.
Do not start in women of reproductive age without two methods of contraception (lenalidomide is teratogenic).
Do not use in transplant-eligible patients — D-VRd (IND-MM-1L-DVRD) is the appropriate plan for transplant-eligible patients.
Do not reduce dexamethasone without clinical indication in first 6 cycles — steroid dose reduction at this point may reduce anti-CD38 efficacy.

Monitoring schedule

Monitoring schedule by treatment phase

Standard plan · MON-VRD-REGIMEN

Phase	Window	Tests	Checkpoints
Baseline	Within 2 weeks before cycle 1	TEST-CBC, TEST-CMP, TEST-LFT, TEST-LDH, TEST-B2-MICROGLOBULIN, TEST-IMMUNOGLOBULINS, TEST-SPEP-UPEP, TEST-FREE-LIGHT-CHAINS, TEST-HBV-SEROLOGY, TEST-FISH-PANEL, TEST-BM-ASPIRATE, TEST-BM-TREPHINE, TEST-WHOLE-BODY-MRI, TEST-ECHO	Confirm CD138+ plasma cell percentage and FISH cytogenetic risk category R-ISS / R2-ISS staging documented Confirm HBV status and prophylaxis plan if anti-CD38 or anti-CD20 in regimen Dental evaluation before zoledronate / denosumab Red-cell phenotyping BEFORE first daratumumab dose
On treatment	Day 1 of every 28-day cycle + mid-cycle CBC for high-risk patients	TEST-CBC, TEST-CMP, TEST-LFT, TEST-FREE-LIGHT-CHAINS, TEST-SPEP-UPEP	ANC ≥ 1000/µL and platelets ≥ 75K before each cycle (delay or reduce otherwise) Neuropathy grade documented at each visit (NCCN/CTCAE) Renal function trend (lenalidomide dose adjustment if CrCl drops) Glucose monitoring for steroid-induced hyperglycemia
Response assessment	After cycles 2 and 4 (before transplant) or every 2-3 cycles (transplant-ineligible)	TEST-FREE-LIGHT-CHAINS, TEST-SPEP-UPEP, TEST-IMMUNOGLOBULINS, TEST-BM-ASPIRATE, TEST-WHOLE-BODY-MRI	IMWG response criteria (sCR, CR, VGPR, PR, MR, SD, PD) MRD assessment by flow cytometry or NGS at suspected CR If <PR after cycle 2 → consider regimen change or trial enrollment
Post-transplant consolidation	Cycles 5-6 post-transplant (transplant-eligible only)	TEST-CBC, TEST-CMP, TEST-FREE-LIGHT-CHAINS, TEST-SPEP-UPEP	Recovery of counts post-transplant before consolidation start Confirm depth of response before starting maintenance
Maintenance	Lenalidomide 10-15 mg daily until progression or intolerance	TEST-CBC, TEST-CMP, TEST-FREE-LIGHT-CHAINS, TEST-SPEP-UPEP	Surveillance for second primary malignancies (annual skin / GU exam) Lenalidomide dose adjustment if cytopenias or worsening renal function Annual influenza + pneumococcal vaccination (non-live only)
Progression monitoring	On clinical or biochemical progression	TEST-FREE-LIGHT-CHAINS, TEST-SPEP-UPEP, TEST-BM-ASPIRATE, TEST-FISH-PANEL, TEST-WHOLE-BODY-MRI	IMWG progression criteria (>25% increase in M-protein, new lytic lesions, hypercalcemia, etc.) Re-do FISH on relapse — high-risk clones may emerge

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Baseline

Within 2 weeks before cycle 1

Induction · Bortezomib + Lenalidomide + Dexamethasone (VRd), 4-6 induction cycles

28-day cycles × 4 cycles before stem-cell harvest (transplant-eligible) OR 8-12 cycles total (transplant-ineligible)

Response assessment

After cycles 2 and 4 (before transplant) or every 2-3 cycles (transplant-ineligible)

Maintenance

Lenalidomide 10-15 mg daily until progression or intolerance

Aggressive plan

Baseline

Within 2 weeks before cycle 1

Induction · Daratumumab + Bortezomib + Lenalidomide + Dexamethasone (D-VRd), 4-6 induction cycles

28-day cycles × 4 cycles before stem-cell harvest (transplant-eligible) OR 6 cycles induction + maintenance (transplant-ineligible per MAIA-style schedule)

Response assessment

After cycles 2 and 4 (before transplant) or every 2-3 cycles (transplant-ineligible)

Maintenance

Lenalidomide 10-15 mg daily until progression or intolerance

Standard plan

Baseline

Within 2 weeks before cycle 1

Induction · Lenalidomide + Dexamethasone continuous (Rd, MAIA control arm — MM 1L transplant-ineligible)

28-day cycles × Continuous until progression or unacceptable toxicity

Response assessment

After cycles 2 and 4 (before transplant) or every 2-3 cycles (transplant-ineligible)

Maintenance

Lenalidomide 10-15 mg daily until progression or intolerance

Aggressive plan

Baseline

Within 2 weeks before cycle 1

Induction · Daratumumab + Lenalidomide + Dexamethasone (D-Rd, MAIA — MM 1L transplant-ineligible)

28-day cycles × Continuous until progression or unacceptable toxicity

Response assessment

After cycles 2 and 4 (before transplant) or every 2-3 cycles (transplant-ineligible)

Maintenance

Lenalidomide 10-15 mg daily until progression or intolerance

MDT brief

Discussion questions (1, 0 blocking)

OQ-LDH-CURRENT
What is the current LDH? Marker of tumor burden and transformation.
LDH is part of the prognostic indices of indolent lymphomas.
→ hematologist

MDT talk tree (2 steps)

#	Owner	Topic	Action
1	hematologist	Staging / disease burden	What is the current LDH? Marker of tumor burden and transformation.
2	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.

Skills (recommended) — for consideration (1)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.

Data quality

Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.

Biomarker coverage: 2/2 known (100%), 0 missing, 0 default-track gaps
Unevaluated RedFlags: RF-ISS-1, RF-ISS-3, RF-MM-BCMA-EXPRESSION-POS, RF-MM-CD38-EXPRESSION-DARA-CANDIDATE, RF-MM-CORD-COMPRESSION, RF-MM-FRAILTY-AGE, RF-MM-HIGH-RISK-CYTOGENETICS, RF-MM-HYPERCALCEMIA, RF-MM-HYPERVISCOSITY, RF-MM-INFECTION-SCREENING, RF-MM-T11-14-ACTIONABLE, RF-MM-TRANSFORMATION-PROGRESSION, RF-R-ISS-3-HIGH-RISK

Technical MDT skill metadata (1/16 activated in this plan)

All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).

Specialist	skill_id	Version	Last reviewed	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	cellular_therapy

Sources cited

SRC-GRIFFIN-VOORHEES-2020: Daratumumab, lenalidomide, bortezomib, and dexamethasone for transplant-eligible newly diagnosed multiple myeloma (GRIFFIN) (2020)
SRC-MAIA-FACON-2019: Daratumumab plus Lenalidomide and Dexamethasone for Untreated Myeloma (2019)
SRC-NCCN-MM-2025: NCCN Clinical Practice Guidelines in Oncology: Multiple Myeloma (v.X.2025)
SRC-PERSEUS-SONNEVELD-2024: Daratumumab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple Myeloma (2024)

Experimental options (clinical trials)

Third plan track — open-enrollment trials from ClinicalTrials.gov. Render-time metadata; engine selection is not affected by this block (CHARTER §8.3). Last synced: 2026-09-09.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT05706766	Prehabilitation Exercise Training in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation	NA	RECRUITING	Dana-Farber Cancer Institute	—	Small N (<50) Single country
NCT05892393	Imaging Study of [89Zr]DFO-YS5 for Detecting CD46 Positive Malignancy in Multiple Myeloma	PHASE1	RECRUITING	Robert Flavell, MD, PhD	—	Phase 1 only Small N (<50) Single country
NCT07582432	A Clinical Trial to Evaluate Efficacy, Safety, and Pharmacokinetics of Gamunex in Participants With Chronic Lymphocytic Leukemia, Multiple Myeloma, or Non-Hodgkin Lymphoma	PHASE3	RECRUITING	Grifols Biologicals, LLC	—	Small N (<50) Single country
NCT06350994	Early Assessment of Cardiac Function After Treatment With CAR-T Cells	N/A	RECRUITING	Assistance Publique - Hôpitaux de Paris	—	Single country
NCT07266441	A Study of JNJ-79635322 in Participants With Relapsed or Refractory Multiple Myeloma	PHASE2	RECRUITING	Janssen Research & Development, LLC	—	Surrogate endpoint only
NCT07292272	Halt Aging in Survivors of Blood Cancers	NA	RECRUITING	University of Nebraska	—	Single country
NCT06153251	A Study to Assess BMS-986453 in Participants With Relapsed and/or Refractory Multiple Myeloma	PHASE1	RECRUITING	Juno Therapeutics, Inc., a Bristol-Myers Squibb Company	—	Phase 1 only
NCT06484777	A Clinical Study of SHR-9539 in Patients With Multiple Myeloma	PHASE1	RECRUITING	Suzhou Suncadia Biopharmaceuticals Co., Ltd.	—	Phase 1 only Single country
NCT06896916	Study of Intravenously (IV) Infused Etentamig in Combination With an Oral Cereblon E3 Ligase Modulatory Drug (CELMoD) Agent Assessing Adverse Events and Change in Disease Activity in Adult Participants With Relapsed or Refractory Multiple Myeloma	PHASE1	RECRUITING	AbbVie	—	Phase 1 only
NCT05136807	Quality of Life in Patients With Asymptomatic Monoclonal Gammopathies	N/A	RECRUITING	M.D. Anderson Cancer Center	—	Single country

Verify recruitment status directly with the trial site. ctgov data can lag behind current UA-site status.

Option availability in Ukraine

Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).

Option	UA registration	NSZU	Cost orientation	Access pathway
Standard plan Bortezomib + Lenalidomide + Dexamethasone (VRd), 4-6 induction cycles (REG-VRD)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Aggressive plan Daratumumab + Bortezomib + Lenalidomide + Dexamethasone (D-VRd), 4-6 induction cycles (REG-DARA-VRD)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan Lenalidomide + Dexamethasone continuous (Rd, MAIA control arm — MM 1L transplant-ineligible) (REG-RD-CONTINUOUS)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Aggressive plan Daratumumab + Lenalidomide + Dexamethasone (D-Rd, MAIA — MM 1L transplant-ineligible) (REG-D-RD-MAIA)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT05706766 Prehabilitation Exercise Training in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05892393 Imaging Study of [89Zr]DFO-YS5 for Detecting CD46 Positive Malignancy in Multiple Myeloma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07582432 A Clinical Trial to Evaluate Efficacy, Safety, and Pharmacokinetics of Gamunex in Participants With Chronic Lymphocytic Leukemia, Multiple Myeloma, or Non-Hodgkin Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06350994 Early Assessment of Cardiac Function After Treatment With CAR-T Cells No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07266441 A Study of JNJ-79635322 in Participants With Relapsed or Refractory Multiple Myeloma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07292272 Halt Aging in Survivors of Blood Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06153251 A Study to Assess BMS-986453 in Participants With Relapsed and/or Refractory Multiple Myeloma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06484777 A Clinical Study of SHR-9539 in Patients With Multiple Myeloma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06896916 Study of Intravenously (IV) Infused Etentamig in Combination With an Oral Cereblon E3 Ligase Modulatory Drug (CELMoD) Agent Assessing Adverse Events and Change in Disease Activity in Adult Participants With Relapsed or Refractory Multiple Myeloma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05136807 Quality of Life in Patients With Asymptomatic Monoclonal Gammopathies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-09-09.

plan_id: PLAN-MM-STD-001-V1 | version: 1 | generated: 2026-09-09T12:26:40.731369+00:00

Per FDA non-device CDS positioning (CHARTER §15): Outpatient oncology treatment planning to support tumor-board discussion. Not a medical device; not for autonomous clinical decision-making.

Per FDA non-device CDS positioning (CHARTER §15): Both treatment options below are presented for review. The engine's selection of a 'recommended' default does not constitute a clinical decision. Final treatment selection requires HCP judgment incorporating information not available to the system.

This document is an informational resource supporting tumor-board discussion (per CHARTER §11). It is not a system that makes clinical decisions. Every recommendation must be verified by the treating physician.