When, if ever, would you choose a two-drug regimen instead of three drug regimen first line in patients with transplant-ineligible Myeloma?  

Poor performance status, multiple co-morbidities, or severe neuropathy; a doublet regimen is sufficient in these patients.

Daratumumab is generally well tolerated so would at least consider DaraRd triplet regimen as per the MAIA trial, since there is already FDA approval of this combination for transplant-ineligible newly diagnosed MM patients. Now with SQ Dara also approved and more widely available, this regimen is mo...

I may choose a dose-attenuated two-drug regimen for the elderly/frail folks with standard risk. For high-risk folks, a 3-drug multi-MOA approach is optimal, but again we dose-attenuate in elderly/frail.

The initial treatment of newly diagnosed multiple myeloma should be dictated by a variety of different factors including the eligibility to undergo stem cell transplant as well as the underlying genetic risk status. While the default choice is a 3 drug regimen for newly diagnosed myeloma that incorp...