Systemic Anti-Cancer Therapy Regimen Library
PCN MM - LenBorDex [lenalidomide, bortezomib, and dexamethasone] induction followed by autologous stem cell transplant
Treatment Overview
Induction - early stem cell mobilisation advised between cycles 2 to 4 due to negative impact of lenalidomide on stem cell yield. Followed by autologous stem cell transplantation.
Cycles 1 to 6 - 28 days
Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol. Other routes of administration may be fatal .
Cycle details
Cycles 1 to 6 - 28 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| dexamethasone * | 40 mg flat dosing | oral administration | 1, 8, 15, 22 |
|
| lenalidomide * | 25 mg Once daily | oral administration | 1 to 21 | |
| bortezomib * | 1.5 mg/m² | subcutaneous injection | 1, 8, 15, 22 |
Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol. Other routes of administration may be fatal .
Full details
Cycles 1 to 6 - 28 days
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 40 mg flat dosing | oral administration |
Instructions:
Take in the morning with food. |
|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
|
| bortezomib * | 1.5 mg/m² | subcutaneous injection |
Instructions:
Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol. Other routes of administration may be fatal. |
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 5
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 6
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 7
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 8
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 40 mg flat dosing | oral administration |
Instructions:
Take in the morning with food. |
|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
|
| bortezomib * | 1.5 mg/m² | subcutaneous injection |
Instructions:
Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol. Other routes of administration may be fatal. |
Day: 9
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 10
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 11
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 12
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 13
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 14
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 15
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 40 mg flat dosing | oral administration |
Instructions:
Take in the morning with food. |
|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
|
| bortezomib * | 1.5 mg/m² | subcutaneous injection |
Instructions:
Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol. Other routes of administration may be fatal. |
Day: 16
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 17
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 18
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 19
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 20
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 21
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| lenalidomide * | 25 mg Once daily | oral administration |
Instructions:
Additional details:
Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew. |
Day: 22
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 40 mg flat dosing | oral administration |
Instructions:
Take in the morning with food. |
|
| bortezomib * | 1.5 mg/m² | subcutaneous injection |
Instructions:
Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol. Other routes of administration may be fatal. |
Additional details
Section 1: Teratogenic effects
All patients must fulfil the requirements of the pregnancy prevention risk management programme to ensure pregnant women are not exposed to lenalidomide.
Supportive Care Factors
| Factor | Value |
|---|---|
| Antiviral prophylaxis for herpes virus: | Routine antiviral prophylaxis recommended |
| Emetogenicity: | Minimal to low |
| Gastroprotection: | Gastroprotection may be considered |
| Pneumocystis jirovecii pneumonia (PJP) prophylaxis: | Routine antibiotic prophylaxis recommended |
| Thromboprophylaxis: | Thromboprophylaxis is recommended |
| Tumour lysis syndrome prophylaxis: | Tumour lysis syndrome prophylaxis may be considered |
Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.
References
Juno Pharmaceuticals NZ Ltd. Bortezomib JUNO New Zealand medicine datasheet 6 April 2020 https://www.medsafe.govt.nz/profs/datasheet/b/bortezomibjunoinj.pdf (Accessed 31 March 2022).
Celgene Limited Revlimid New Zealand Datasheet 27 January 2022 https://www.medsafe.govt.nz/profs/datasheet/r/revlimidcap.pdf (Accessed 31/3/2022).
Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.
* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.
s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.