4th May 2024

A 68-year-old man with newly diagnosed multiple myeloma presents for consultation regarding treatment options.

A 68-year-old man with newly diagnosed multiple myeloma presents for consultation regarding treatment options. He has a history of chronic kidney disease and hypertension. His performance status is good and he is considered a transplant candidate. Laboratory investigations show:

White cell count: 9.2 x 10⁹/L (4.0–11.0)

Haemoglobin: 102 g/L (115–150)

Platelets: 210 x 10⁹/L (150–400)

Calcium: 2.6 mmol/L (2.2–2.6)

Creatinine: 176 µmol/L (60-110)

Based on the initial management of newly diagnosed transplant candidates with multiple myeloma and considering his chronic kidney disease, which is the most appropriate first-line induction therapy for this patient?