- 1.3 mg/m2 IV in combination with oral melphalan & prednisolone for nine 6 wk treatment cycles as follows
- Cycles 1-4: 1.3 mg/m2IV twice weekly, administer on days 1, 4, 8, 11, 22, 25, 29 and 32 of 42 day cycle
- Cycles 5-9: 1.3 mg/m2 IV twice weekly, administer on days 1, 8, 22 and 29 of 42 day cycle
- Dose modification based on toxicity
- Platelet count should be
70 x 10 9/L and ANC should be 1.0 x 10 9/L before starting therapy - Non hematological toxicities should resolve to Grade 1 or baseline
- Grade 4 neutropenia/thrombocytopenia: Reduce melphalan dose by 25% in next cycle
- Thrombocytopenia with bleeding: Reduce melphalan dose by 25% in next cycle
- Platelet count
30 x 109/L or ANC 0.75 x 109/L on day of dosing (other than day 1): Withheld dose - If several doses are withheld due to toxicity: Reduce dose from 1.3 mg/m2 to 1 mg/m2 or from 1 mg/m2 to 0.7 mg/m2
- Grade 3 non-hematological toxicities: Withheld therapy until toxicity resolves to grade 1 or baseline, then restart with one dose level reduction (from 1.3 mg/m2 to 1 mg/m2 or from 1 mg/m2 to 0.7 mg/m2)
Treatment experienced adults; relapsed multiple myeloma
- 1.3 mg/m2 twice weekly for 2 wks (days 1, 4, 8 and 11) then 10 days off (days 12-21)
- If extended therapy (> 8 cycles), may give qwk for 4 wks (days 1, 8, 15 and 22) then 13 days off
- Dose modifications based on toxicity
- Grade 3 non hematological toxicity: Withheld dose; reduce dose by 25% and restart once symptoms of toxicity resolve
- Grade 4 hematological toxicity: Withheld dose; reduce dose by 25% and restart once symptoms of toxicity resolve
- 1.3 mg/m2 twice weekly for 2 wks (days 1, 4, 8 and 11) then 10 days off (days 12-21)
- If extended therapy (> 8 cycles), may give qwk for 4 wks (days 1, 8, 15 and 22) then 13 days off
- Dose modifications based on toxicity
- Grade 3 non hematological toxicity: Withheld dose; reduce dose by 25% and restart once symptoms of toxicity resolve
- Grade 4 hematological toxicity: Withheld dose; reduce dose by 25% and restart once symptoms of toxicity resolve
Dose modifications for bortezomib related neuropathic pain and/or peripheral sensory or motor neuropathy
- Grade 1 without pain or loss of function: Continue recommended dosage
- Grade 1 with pain or Grade 2 (interfering w/function but no ADL restriction): Reduce dosage to 1 mg/m2
- Grade 2 with pain or Grade 3 (interfering w/ ADL): Withhold until toxicity resolves, then reinitiate w/ 0.7 mg/m2 and change treatment schedule to once weekly
- Grade 4 (disabling sensory neuropathy/life-threatening motor neuropathy): Discontinue therapy
- Safety and effectiveness in children have not been established
