Onco Wiki / Indicação

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

Visão determinística da entidade fonte YAML. A autoridade clínica permanece com os IDs de fonte citados e estado de assinatura do revisor.

Registro de base de conhecimento para auditoria. Conteúdo clínico provisório: não é uma prescrição. Um oncologista deve verificar fontes originais, aplicabilidade e estado de revisão. Regras completas e restrições estão no YAML.

Fonte YAML: registo completo

Notas

STUB — requires clinical co-lead signoff before publication. Aggressive counterpart to IND-MM-1L-RD for two-plan output in transplant-ineligible NDMM (CHARTER §2). Major access constraint in Ukraine: daratumumab is not currently НСЗУ-reimbursed — funding pathway (clinical trial / charitable / out-of-pocket) MUST be confirmed BEFORE this Plan is finalized. Red-cell phenotyping (type and screen) BEFORE first daratumumab dose is mandatory due to anti-CD38 interference with crossmatching. MAIA trial (Facon NEJM 2019, PMID 30926586): 737 transplant-ineligible NDMM patients randomized D-Rd vs Rd. Primary endpoint PFS: HR 0.56 (95% CI 0.43–0.73), p<0.001. 5-year OS update (Facon JCO 2024): 66.3% vs 53.1% (HR 0.66, p<0.0001) — first OS benefit for an anti-CD38 doublet addition in TI-NDMM. Scope gate: fit_for_transplant: false restricts IND-MM-1L-DARA-RD to transplant-ineligible patients. For transplant-eligible aggressive-plan patients, see IND-MM-1L-DVRD (D-VRd + ASCT + dara-len maintenance). Treatment is continuous until progression or unacceptable toxicity — no fixed-duration transplant pathway. No phases block needed (single continuous regimen, no ASCT step).

Usado por

Algoritmos

• ALGO-MM-1L - ALGO-MM-1L

Indicação

• IND-MM-1L-RD - IND-MM-1L-RD