1. Rafael Fonseca MD Chair, Department of Medicine Mayo Clinic in AZ Of the following frontline options for transplant-ineligible MM, which would you recommend? • Rd until progression
Scottsdale, Arizona
Rochester, Minnesota
Jacksonville, Florida
Mayo Clinic College of Medicine
Mayo Clinic Comprehensive Cancer Center

2. Disclosures
Consulting: AMGEN, Genzyme, BMS, Otsuka, Celgene, Medtronic, Lilly, Millennium, Binding Site, Onyx, Bayer
Speakers Bureaus: None
Research: Cylene, Proteolix
Patent for FISH based prognostication in MM - about $1500 per year
Registered independent
Believe in stem cell transplant
Dislike wasting your time with this slide

3. IMIDs
Thalidomide Lenalidomide Pomalidomide

4. E4A04

5. Blood 2008

6. Blood 2008

8. Cytogenetic Category and Age

9. Cytogenetic Category and Age
Kappor, P Blood 2009
Fonseca, R Br J Haematol 2011

10. Is this unique to myeloma?
CML European studies of imatinib
Tamoxifen and breast cancer
Lung cancer

11. What not to do when treating the elderly:
Mix lenalidomide & alkylators
Use injections
Use melphalan
Use growth factor
Interfere with QOL
Use too much steroid
Ask patients to drive too much

12. Drive through
“Thanks your for shopping at Starbucks. We will have your Rd pills in a second”