Updated FAQs on newly diagnosed multiple myeloma for 2026! 1. Which frontline regimen to use? Quad regimen, either Dara-VRd or Isa-VRd 2. How long to give the Quad regimen? 4 months and then transplant, or 6 months if transplant ineligible or deferred 3. What maintenance after initial therapy? Standard risk: Dara or Isa plus Lenalidomide High Risk: Dara or Isa plus Lenalidomide; or bortezomib plus Lenalidomide 4. How long to give maintenance? Standard risk: Lenalidomide for 2 years and stop; Dara or Isa till progression. High risk: Till progression. 5. Is transplant still recommended in eligible patients? High risk myeloma: Yes. Standard risk: Early vs delayed- Shared decision making based on age and patient preference. 6. Definition of High risk myeloma? Del 17p is high risk by itself All the others (4;14, 1q, 1p, etc) all need two abnormalities together to call as high risk. (P53 mutation and bi-allelic del 1p also high risk; but small numbers) Check out myelomarisk.com to make this assessment easily. 7. What about CART or bispecifics in newly diagnosed myeloma. Totally Investigational. Done only on approved clinical trials 8. What about frail patients who cannot tolerate quadruplet? Triplet: DaraRd or IsaRd; if that’s not possible or safe: Rd or even single agent Dara may sometimes be needed at least initially till performance status improves. 9. What about patients with acute renal failure? Prefer Dara-VCd rather than Dara-VRd 10. How long to give the Dex? Keep Dex only for initial 4-6 months. No dex in maintenance.