But with myeloma therapy typically given in combinations, what does a "line" include? It was confusing enough for myeloma experts Vincent Rajkumar, MD (Mayo Clinic), Paul Richardson, MD (Dana Farber Cancer Institute) and Jesus San Miguel, MD, PhD (University of Navarra, Spain) to better define the criteria in an article in Blood.
One line of therapy consists of any of the following:
Seems like a lot of therapy for one line, right? But it's still considered one line of therapy.
A new line of therapy would be considered:
Examples might include:
Lenalidomide plus low-dose dexamethasone (RD) as initial therapy, and due to inadequate response, bortezomib is added (RVD): This is counted as 2 lines.
Toxicity with lenalidomide plus dex as pre-transplant induction, and therefore treatment is switched to bortezomib, cyclophosphamide, and dexamethasone (VCD): RD is counted as 1 line; VCD (and subsequent planned SCT) is line 2.
Post-transplant observation without maintenance, and then, due to paraprotein rise 6 months later, lenalidomide is started, which is not planned maintenance; hence, lenalidomide will be considered as a new line.
If you have other questions on what may qualify you for specific clinical trials, ask your doctor or nurse about your prior lines of therapy. Staying informed is always a smart way to get the most out of your treatment.
about the author
Myeloma survivor, patient advocate, wife, mom of 6. Believer that patients can help accelerate a cure by weighing in and participating in clinical research. Founder of Myeloma Crowd by HealthTree and the HealthTree Foundation.