NCCN Clinical Practice Guidelines in Oncology (NCCN ...

1 nccn Guidelines IndexMultiple myeloma Table of ContentsDiscussionVersion , 11/08/13 National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of nccn . ContinueNCCN Clinical Practice Guidelines in Oncology ( nccn Guidelines ) multiple MyelomaVersion Guidelines IndexMultiple myeloma Table of ContentsDiscussionVersion , 11/08/13 National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of nccn . Noopur Raje, MD Dana-Farber/Brigham and Women sCancer Center | Massachusetts General HospitalCancer CenterSeema Singhal, MD Robert H.

2 Lurie Comprehensive CancerCenter of Northwestern UniversityGeorge Somlo, MD City of Hope Comprehensive Cancer CenterKeith Stockerl-Goldstein, MD Siteman Cancer Center at Barnes-Jewish Hospitaland Washington University School of MedicineSteven P. Treon, MD, PhD Dana-Farber/Brigham and Women'sCancer Center | Massachusetts GeneralHospital Cancer CenterDonnaWeber, MD The University of TexasMD Anderson Cancer CenterJoachim Yahalom, MD Memorial Sloan-Kettering Cancer CenterxM.*Cristina Gasparetto, MD Duke Cancer InstituteFrancisco Hernandez-Ilizaliturri, MD Roswell Park Cancer InstituteCarol Ann Huff, MD The Sidney Kimmel ComprehensiveCancer Center at Johns HopkinsAdetola Kassim, MD Vanderbilt-Ingram Cancer CenterAmrita Y.

3 Krishnan, MD City of Hope Comprehensive Cancer CenterMichaela Liedtke, MD Stanford Cancer InstituteMatthew Lunning, MD Fred & Pamela Buffett Cancer Center at TheNebraska Medical CenterRuby Meredith, MD, PhD University of Alabama at BirminghamComprehensive Cancer CenterxContinueKenneth C. Anderson, MD/Chair Dana-Farber/Brigham and Women'sCancer Center | Massachusetts GeneralHospital Cancer CenterMelissa Alsina, MD Moffitt Cancer CenterJ. Sybil Biermann, MD University of MichiganComprehensive Cancer CenterJason C. Chandler, MDSt. Jude Children s Research Hospital/The University of Tennessee HealthScience CenterSteven Devine, MDThe Ohio State University ComprehensiveCancer Center - James Cancer Hospitaland Solove Research InstituteBenjamin Djulbegovic, MD, PhD Moffitt Cancer CenterWilliam Bensinger, MD/Vice-Chair Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance xxCaitlin Costello.

4 MDUC San Diego Moores Cancer Center x Medical Oncology HematologyBone marrow transplantation Surgery/Surgical Oncology Radiotherapy/Radiation Oncology * Writing committee memberx Internal medicineNCCN Guidelines Panel DisclosuresNCCN Guidelines Version myeloma - Panel MembersNCCN StaffRashmi Kumar, PhDDorothy A. Shead, MS*Printed by Eliot Williams on 6/11/2014 11:11:56 AM. For personal use only. Not approved for distribution. Copyright 2014 National Comprehensive Cancer Network, Inc., All Rights Guidelines IndexMultiple myeloma Table of ContentsDiscussionVersion , 11/08/13 National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of nccn .

5 nccn multiple myeloma Panel MembersSummary of Guidelines UpdatesDiagnostic Workup and Clinical Presentation (MYEL-1)Solitary Plasmacytoma ((MYEL-2) multiple myeloma : Primary treatment and Follow-Up / Surveillance (MYEL-3)Active (Symptomatic) myeloma Follow-Up / Surveilliance (MYEL-4)Additional treatment Post Stem Cell Transplant (MYEL-5)Active Disease: Additional treatment for Relapse or Progressive Disease (MYEL-6)Staging Systems for multiple myeloma (MYEL-A)Definition of multiple myeloma (Smoldering and Active) (MYEL-B)Response Criteria for multiple myeloma (MYEL-C) myeloma Therapy (MYEL-D)Adjunctive treatment (MYEL-E)Osseous or Extraosseous) Primary TreatmentInitialClinical Trials:Categories of Evidence andConsensus.

6 NCCNAll recommendationsare category 2A unless thatthe best management for any cancerpatient is in a Clinical in Clinical trials isespecially find Clinical trials online at NCCNM ember Institutions,click of Evidenceand ConsensusThe nccn Guidelines are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to clinician seeking to apply or consult the nccn Guidelines is expected to use independent medical judgment in the context of individual clinicalcircumstances to determine any patient s care or treatment . The National Comprehensive Cancer Network ( nccn ) makes no representations orwarranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way.

7 The NCCNG uidelines are copyrighted by National Comprehensive Cancer Network . All rights reserved. The nccn Guidelines and the illustrations herein maynot be reproduced in any form without the express written permission of nccn . 2013. nccn Guidelines Version myeloma - Table of ContentsPrinted by Eliot Williams on 6/11/2014 11:11:56 AM. For personal use only. Not approved for distribution. Copyright 2014 National Comprehensive Cancer Network, Inc., All Rights Guidelines IndexMultiple myeloma Table of ContentsDiscussionVersion , 11/08/13 National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of nccn .

8 Note: All recommendations are category 2A unless otherwise Trials: nccn believes that the best management of any cancer patient is in a Clinical trial. Participation in Clinical trials is especially in Version of the nccn Guidelines for multiple myeloma from Version include: nccn Guidelines Version myeloma - UpdatesMYEL-3 Added the following footnote to Smoldering (asymptomatic) myeloma : A relatively small randomized prospective study has shown benefitof early treatment with lenalidomide and dexamethasone for a subset of patients with smoldering myeloma with certain high-risk featurespredictive for early Clinical progression (Mateos MV, Hernandez M, Giraldo P, et al.)

9 Lenalidomide plus dexamethasone for high-risksmoldering multiple myeloma . N Engl J Med 2013;369:438-447). However, the high-risk criteria specified in the study are not in common criteria are under investigation (Dispienzeri A, Kyle R, Katzmann J, et al. Immunoglobulin free light chain ratio is an independentrisk factor for progression of smoldering (asymptomatic) multiple myeloma . Blood 2008;111:785-789). The nccn panel strongly recommendsenrolling eligible smoldering myeloma patients with high-risk criteria in Clinical trials. Definition of multiple myeloma , modified the table for Smoldering (Asymptomatic) myeloma to include: IgG 3 g/dL; IgA > 1 g/dL or Bence-Jones protein >1 g/24h.

10 Added the following footnote to Smoldering (asymptomatic) myeloma : The understanding of smoldering (asymptomatic) myeloma isevolving rapidly. Some studies have shown that patients with certain characteristics including IgG levels of > 3 g/dL, IgA of > 2 g/dL, orurinary Bence Jones protein of > 1 g/24 hours (Mateos MV, Hernandez M, Giraldo P, et al. Lenalidomide plus dexamethasone for high-risksmoldering multiple myeloma . N Engl J Med 2013;369:438-447) or abnormal free light chain ratios (Dispienzeri A, Kyle R, Katzmann J, et free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma . Blood2008;111:785-789), have an increased risk of progression to active (symptomatic) myeloma .