Q:

Which of the following treatment regimens would not be appropriate for a patient who is consid ered a candidate for bone marrow transplantation?

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A 79-year-old Caucasian man presents with a chief complaint of back pain. Hemoglo bin is 9.7 g/dl. leukocyte count 7.600/Jll. and platelet count 21 LJ,OOO/fll. BUN is 26 mg/dl. creatinine 2.1 mg/dl. total protein 9.0 g/dl. albumin 3.1 g/dl. and calcium 10.9 mg/dl. The images below show the bone marrow aspirate and a skull film from the skeletal survey. 

Which of the following treatment regimens would not be appropriate for a patient who is consid ered a candidate for bone marrow transplantation? 


  1. Melphalan -prednisone-lenalidomide
  2. Bortezomib-lenalidomide-dexamethasone
  3. Lenalidomide-dexamethasone
  4. Thalidomide-dexamethasone

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A. Alkylating agents, such as melphalan, are not recommended in patients who are trans plant -eligible because these agents damage hematopoietic stem cells and interfere with adequate stem cell mobilization. 

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