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Systemic Anti-Cancer Therapy Regimen Library

Home > PCN MM - daratumumab [subcut], lenalidomide and dexamethasone

PCN MM - daratumumab [subcut], lenalidomide and dexamethasone

Treatment Overview

Cycle 1 - 28 days

Cycle length:
28

Dexamethasone dose: Consider dose reduction of dexamethasone to 20 mg orally ONCE a week for patients over 75 years, BMI less than 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy. For patients on a reduced dexamethasone dose, the entire 20 mg dose was given as pre-injection medication.

 

In patients with chronic obstructive pulmonary disease (COPD): Also consider additional post-dose medication (e.g. inhaled corticosteroids, short- and long-acting bronchodilators) to manage respiratory complications should they occur. Post-dose inhaled medication may be discontinued following the first 4 administrations at the prescriber’s discretion if there has been no major administration reaction.

Cycle 2 - 28 days

Cycle length:
28

Dexamethasone dose: Consider dose reduction of dexamethasone to 20 mg orally ONCE a week for patients over 75 years, BMI less than 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy. For patients on a reduced dexamethasone dose, the entire 20 mg dose was given as pre-injection medication.

 

In patients with chronic obstructive pulmonary disease (COPD): Also consider additional post-dose medication (e.g. inhaled corticosteroids, short- and long-acting bronchodilators) to manage respiratory complications should they occur. Post-dose inhaled medication may be discontinued following the first 4 administrations at the prescriber’s discretion if there has been no major administration reaction.

Cycles 3 to 6 - 28 days

Cycle length:
28

Dexamethasone dose: Consider dose reduction of dexamethasone to 20 mg orally ONCE a week for patients over 75 years, BMI less than 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy. For patients on a reduced dexamethasone dose, the entire 20 mg dose was given as pre-injection medication.

 

In patients with chronic obstructive pulmonary disease (COPD): Also consider additional post-dose medication (e.g. inhaled corticosteroids, short- and long-acting bronchodilators) to manage respiratory complications should they occur. Post-dose inhaled medication may be discontinued following the first 4 administrations at the prescriber’s discretion if there has been no major administration reaction.

Cycle 7 (and all further cycles) - 28 days

Cycle length:
28

Dexamethasone dose: Consider dose reduction of dexamethasone to 20 mg orally ONCE a week for patients over 75 years, BMI less than 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy. For patients on a reduced dexamethasone dose, the entire 20 mg dose was given as pre-injection medication.

 

In patients with chronic obstructive pulmonary disease (COPD): Also consider additional post-dose medication (e.g. inhaled corticosteroids, short- and long-acting bronchodilators) to manage respiratory complications should they occur. Post-dose inhaled medication may be discontinued following the first 4 administrations at the prescriber’s discretion if there has been no major administration reaction.

Cycle details

Cycle 1 - 28 days

Medication Dose Route Days Max Duration
paracetamol * 1000 mg flat dosing oral administration 1, 8, 15,
22
loratadine * 10 mg oral administration 1, 8, 15,
22
dexamethasone 20 mg flat dosing oral administration 1, 2, 8,
9, 15, 16,
22, 23
montelukast * 10 mg oral administration 1, 8, 15,
22
daratumumab 1800 mg flat dosing subcutaneous injection 1, 8, 15,
22
lenalidomide 25 mg Once daily oral administration 1 to 21

Dexamethasone dose: Consider dose reduction of dexamethasone to 20 mg orally ONCE a week for patients over 75 years, BMI less than 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy. For patients on a reduced dexamethasone dose, the entire 20 mg dose was given as pre-injection medication.

 

In patients with chronic obstructive pulmonary disease (COPD): Also consider additional post-dose medication (e.g. inhaled corticosteroids, short- and long-acting bronchodilators) to manage respiratory complications should they occur. Post-dose inhaled medication may be discontinued following the first 4 administrations at the prescriber’s discretion if there has been no major administration reaction.

Cycle 2 - 28 days

Medication Dose Route Days Max Duration
paracetamol * 1000 mg flat dosing oral administration 1, 8, 15,
22
loratadine * 10 mg oral administration 1, 8, 15,
22
dexamethasone 20 mg flat dosing oral administration 1, 2, 8,
9, 15, 16,
22, 23
daratumumab 1800 mg flat dosing subcutaneous injection 1, 8, 15,
22
lenalidomide 25 mg Once daily oral administration 1 to 21

Dexamethasone dose: Consider dose reduction of dexamethasone to 20 mg orally ONCE a week for patients over 75 years, BMI less than 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy. For patients on a reduced dexamethasone dose, the entire 20 mg dose was given as pre-injection medication.

 

In patients with chronic obstructive pulmonary disease (COPD): Also consider additional post-dose medication (e.g. inhaled corticosteroids, short- and long-acting bronchodilators) to manage respiratory complications should they occur. Post-dose inhaled medication may be discontinued following the first 4 administrations at the prescriber’s discretion if there has been no major administration reaction.

Cycles 3 to 6 - 28 days

Medication Dose Route Days Max Duration
paracetamol * 1000 mg flat dosing oral administration 1, 15
loratadine * 10 mg oral administration 1, 15
dexamethasone 20 mg flat dosing oral administration 1, 2, 8,
9, 15, 16,
22, 23
daratumumab 1800 mg flat dosing subcutaneous injection 1, 15
lenalidomide 25 mg Once daily oral administration 1 to 21

Dexamethasone dose: Consider dose reduction of dexamethasone to 20 mg orally ONCE a week for patients over 75 years, BMI less than 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy. For patients on a reduced dexamethasone dose, the entire 20 mg dose was given as pre-injection medication.

 

In patients with chronic obstructive pulmonary disease (COPD): Also consider additional post-dose medication (e.g. inhaled corticosteroids, short- and long-acting bronchodilators) to manage respiratory complications should they occur. Post-dose inhaled medication may be discontinued following the first 4 administrations at the prescriber’s discretion if there has been no major administration reaction.

Cycle 7 (and all further cycles) - 28 days

Medication Dose Route Days Max Duration
paracetamol * 1000 mg flat dosing oral administration 1
loratadine * 10 mg oral administration 1
dexamethasone 20 mg flat dosing oral administration 1, 2, 8,
9, 15, 16,
22, 23
daratumumab 1800 mg flat dosing subcutaneous injection 1
lenalidomide 25 mg Once daily oral administration 1 to 21

Dexamethasone dose: Consider dose reduction of dexamethasone to 20 mg orally ONCE a week for patients over 75 years, BMI less than 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy. For patients on a reduced dexamethasone dose, the entire 20 mg dose was given as pre-injection medication.

 

In patients with chronic obstructive pulmonary disease (COPD): Also consider additional post-dose medication (e.g. inhaled corticosteroids, short- and long-acting bronchodilators) to manage respiratory complications should they occur. Post-dose inhaled medication may be discontinued following the first 4 administrations at the prescriber’s discretion if there has been no major administration reaction.

Full details

Cycle 1 - 28 days

Day: 1

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
loratadine * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
dexamethasone 20 mg flat dosing oral administration
Instructions:

ONE to THREE hours prior to daratumumab with food.
montelukast * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab as per institutional policy.
daratumumab 1800 mg flat dosing subcutaneous injection Additional details:
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 2

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 3

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 4

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 5

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 6

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 7

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 8

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
loratadine * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
dexamethasone 20 mg flat dosing oral administration
Instructions:

ONE to THREE hours prior to daratumumab with food.
montelukast * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab as per institutional policy.
daratumumab 1800 mg flat dosing subcutaneous injection Additional details:
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 9

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 10

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 11

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 12

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 13

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 14

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 15

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
loratadine * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
dexamethasone 20 mg flat dosing oral administration
Instructions:

ONE to THREE hours prior to daratumumab with food.
montelukast * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab as per institutional policy.
daratumumab 1800 mg flat dosing subcutaneous injection Additional details:
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 16

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 17

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 18

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 19

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 20

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 21

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 22

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
loratadine * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
dexamethasone 20 mg flat dosing oral administration
Instructions:

ONE to THREE hours prior to daratumumab with food.
montelukast * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab as per institutional policy.
daratumumab 1800 mg flat dosing subcutaneous injection Additional details:

Day: 23

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.

Cycle 2 - 28 days

Day: 1

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
loratadine * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
dexamethasone 20 mg flat dosing oral administration
Instructions:

ONE to THREE hours prior to daratumumab with food.
daratumumab 1800 mg flat dosing subcutaneous injection Additional details:
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 2

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 3

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 4

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 5

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 6

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 7

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 8

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
loratadine * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
dexamethasone 20 mg flat dosing oral administration
Instructions:

ONE to THREE hours prior to daratumumab with food.
daratumumab 1800 mg flat dosing subcutaneous injection Additional details:
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 9

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 10

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 11

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 12

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 13

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 14

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 15

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
loratadine * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
dexamethasone 20 mg flat dosing oral administration
Instructions:

ONE to THREE hours prior to daratumumab with food.
daratumumab 1800 mg flat dosing subcutaneous injection Additional details:
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 16

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 17

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 18

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 19

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 20

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 21

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR two hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 22

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
loratadine * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
dexamethasone 20 mg flat dosing oral administration
Instructions:

ONE to THREE hours prior to daratumumab with food.
daratumumab 1800 mg flat dosing subcutaneous injection Additional details:

Day: 23

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.

Cycles 3 to 6 - 28 days

Day: 1

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
loratadine * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
dexamethasone 20 mg flat dosing oral administration
Instructions:

ONE to THREE hours prior to daratumumab with food.
daratumumab 1800 mg flat dosing subcutaneous injection Additional details:
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 2

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 3

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 4

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 5

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 6

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 7

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 8

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 9

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 10

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 11

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 12

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 13

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 14

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 15

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
loratadine * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
dexamethasone 20 mg flat dosing oral administration
Instructions:

ONE to THREE hours prior to daratumumab with food.
daratumumab 1800 mg flat dosing subcutaneous injection Additional details:
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 16

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 17

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 18

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 19

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 20

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 21

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 22

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Day: 23

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.

Cycle 7 (and all further cycles) - 28 days

Day: 1

Medication Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
loratadine * 10 mg oral administration
Instructions:
ONE to THREE hours prior to daratumumab.
dexamethasone 20 mg flat dosing oral administration
Instructions:

ONE to THREE hours prior to daratumumab with food.
daratumumab 1800 mg flat dosing subcutaneous injection Additional details:
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 2

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 3

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 4

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 5

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 6

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 7

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 8

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 9

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 10

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 11

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 12

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 13

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 14

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 15

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 16

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 17

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 18

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 19

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 20

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 21

Medication Dose Route Max duration Details
lenalidomide 25 mg Once daily oral administration
Instructions:

Take each dose on an empty stomach—at least one hour before OR three hours after food. Swallow whole, do not crush or chew.

Additional details:

Day: 22

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Day: 23

Medication Dose Route Max duration Details
dexamethasone 20 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Dose may be omitted for patients > 75 years, BMI < 18.5, poorly controlled diabetes mellitus or prior intolerance to steroid therapy.

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.

Section 2: Patients with COPD

In patients with chronic obstructive pulmonary disease (COPD):  Also consider additional post-dose medication (e.g. inhaled corticosteroids, short- and long-acting bronchodilators) to manage respiratory complications should they occur. Post-dose inhaled medication may be discontinued following the first 4 administrations at the prescriber’s discretion if there has been no major administration reaction

Supportive Care Factors

Factor Value
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Emetogenicity: Minimal to low
Gastroprotection: Gastroprotection may be considered
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Thromboprophylaxis: Thromboprophylaxis is recommended
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis may be considered

Anti CD-38 monoclonal antibody red cell phenotyping and red blood cell antibody screen: Mandatory before starting treatment.

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

Quach, H., S. Benson, H. Haysom, et al. 2018. "Considerations for pre-transfusion immunohaematology testing in patients receiving the anti-CD38 monoclonal antibody daratumumab for the treatment of multiple myeloma." Intern Med J 48(2):210-220. , PMID: 29415351

Morgan, G. J., J. A. Child, W. M. Gregory, et al. 2011. "Effects of zoledronic acid versus clodronic acid on skeletal morbidity in patients with newly diagnosed multiple myeloma (MRC Myeloma IX): secondary outcomes from a randomised controlled trial." Lancet Oncol 12(8):743-752., PMID: 21771568

Dimopoulos, M. A., A. Oriol, H. Nahi, et al. 2016. "Daratumumab, Lenalidomide, and Dexamethasone for Multiple Myeloma." N Engl J Med 375(14):1319-1331. , PMID: 27705267

Bahlis, N., M. Dimopoulos, D. White, et al. 2018. “Three-Year Follow up of the Phase 3 Pollux Study of Daratumumab Plus Lenalidomide and Dexamethasone (D-Rd) Versus Lenalidomide and Dexamethasone (Rd) Alone in Relapsed or Refractory Multiple Myeloma (RRMM)”. Blood 132: 1996., PMID: 32001798

Ajai Chari, Tomer M Mark, Amrita Krishnan, et al., Use of Montelukast to Reduce Infusion Reactions in an Early Access Treatment Protocol of Daratumumab in United States Patients with Relapsed or Refractory Multiple Myeloma. Blood 2016; 128 (22): 2142. doi: https://doi.org/10.1182/blood.V128.22.2142.2142

Celgene Limited Revlimid New Zealand Datasheet 27 January 2022 https://www.medsafe.govt.nz/profs/datasheet/r/revlimidcap.pdf (Accessed 31/3/2022)

Janssen-Cilag (New Zealand) Ltd Daralex SC New Zealand Medicine Datasheet 27 May 2021 https://www.medsafe.govt.nz/profs/datasheet/d/darzalexscinj.pdf (Accessed 4 April 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.