• Out-patient regimen.

• Indwelling central venous catheter required with ambulatory infusion pump.

• Consider sperm banking in males.

• Add allopurinol 300mg/day throughout first treatment cycle.

• Add infection prophylaxis with cotrimoxazole 2 tabs tiw and nystatin mouthwash/fluconazole 100mg/day.

• Antiemetic therapy for mildly emetogenic regimens.

• Repeat treatment when WBC >2.0 x 109/L and platelets >100 x 109/L.

• Treat until maximum paraprotein and bone marrow response (normally 4-6 courses).

CVAD used in MRC/UKMF Study 'Myeloma IX' adds cyclophosphamide 500mg PO (or IV if preferred) on days 1, 8 and 15 of each cycle. Omit cyclophosphamide in patients with a serum creatinine >300^mol/L.

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