NCCN Guidelines for Patients Multiple Myeloma

1 NCCN. Guidelines . FOR Patients .. 2022. 2021. Multiple Myeloma NATIONAL COMPREHENSIVE CANCER NETWORK. Presented with support from: FOUNDATION. Guiding Treatment. Changing Lives. Available online at . Multiple Myeloma It's easy to get lost in the cancer world Let NCCN Guidelines for Patients . be your guide 9 Step-by-step guides to the cancer care options likely to have the best results 9 Based on treatment Guidelines used by health care providers worldwide 9 Designed to help you discuss cancer treatment with your doctors NCCN Guidelines for Patients . Multiple Myeloma , 2022 1. Multiple About Myeloma National Comprehensive Cancer Network . NCCN Guidelines for Patients are developed by the National Comprehensive Cancer Network (NCCN ). NCCN Clinical Practice NCCN Guidelines NCCN Guidelines in Oncology . for Patients (NCCN Guidelines ). An alliance of leading Developed by doctors from Present information from the cancer centers across the NCCN cancer centers using NCCN Guidelines in an easy- United States devoted to the latest research and years to-learn format patient care, research, and of experience education For people with cancer and For providers of cancer care those who support them all over the world Cancer centers Explain the cancer care that are part of NCCN: Expert recommendations for options likely to have the cancer screening, diagnosis, best results and treatment Free online at Free online at NATIONAL COMPREHENSIVE CANCER NETWORK.

2 FOUNDATION. Guiding Treatment. Changing Lives. and supported by funding from NCCN Foundation . These NCCN Guidelines for Patients are based on the NCCN Guidelines for Multiple Myeloma , Version . October 25, 2021. 2021 National Comprehensive Cancer Network, Inc. All rights reserved. NCCN Foundation seeks to support the millions of Patients and their families NCCN Guidelines for Patients and illustrations herein may not be reproduced in affected by a cancer diagnosis by funding and distributing NCCN Guidelines for any form for any purpose without the express written permission of NCCN. No Patients . NCCN Foundation is also committed to advancing cancer treatment one, including doctors or Patients , may use the NCCN Guidelines for Patients for by funding the nation's promising doctors at the center of innovation in cancer any commercial purpose and may not claim, represent, or imply that the NCCN research. For more details and the full library of patient and caregiver resources, Guidelines for Patients that have been modified in any manner are derived visit from, based on, related to, or arise out of the NCCN Guidelines for Patients .

3 The NCCN Guidelines are a work in progress that may be redefined as often National Comprehensive Cancer Network (NCCN) / NCCN Foundation as new significant data become available. NCCN makes no warranties of any 3025 Chemical Road, Suite 100. kind whatsoever regarding its content, use, or application and disclaims any Plymouth Meeting, PA 19462. responsibility for its application or use in any way. NCCN Guidelines for Patients . Multiple Myeloma , 2022 2. Supporters Endorsed by Blood & Marrow Transplant nbmtLINK. information Network (BMT InfoNet). Educating and informing people about their BMT InfoNet provides information and support cancer diagnosis as well as the transplant services to Patients undergoing a bone process is an important part of the National marrow, stem cell or cord blood transplant Bone Marrow Transplant Link's mission and service. Our mission is to empower Patients contributes to the psychosocial support of and their loved ones with reliable information bone marrow/stem cell transplant and CAR.

4 And support about issues before, during T-cell therapy Patients and their caregivers. and after transplant so that they may take For information and resources, call toll free at an active, informed role in managing their 800-LINK-BMT or email healthcare choices. Visit us online at The LINK is supportive of resources like NCCN. , or contact us by email at Guidelines for Patients . and by phone 847-433-3313. The Leukemia & Lymphoma Society Multiple Myeloma Research The Leukemia & Lymphoma Society (LLS). Foundation is dedicated to developing better outcomes for blood cancer Patients and their families The Multiple Myeloma Research Foundation through research, education, support (MMRF) drives discoveries for new and advocacy and is happy to have this treatments, accelerates groundbreaking comprehensive resource available to Patients . clinical trials and fuels the most robust data- driven initiatives in cancer research. Our goal is to find a cure for each and every patient diagnosed with Multiple Myeloma .

5 To make a gift or learn more, please visit or e-mail NCCN Guidelines for Patients . Multiple Myeloma , 2022 3. NCCN Guidelines for Patients . Multiple Myeloma , 2022 4. Multiple Myeloma Contents 6 About Multiple Myeloma 15 Testing for Myeloma 28 Overview of Myeloma treatments 43 Treatment guide 54 Making treatment decisions 63 Words to know 66 NCCN Contributors 67 NCCN Cancer Centers 68 Index NCCN Guidelines for Patients . Multiple Myeloma , 2022 5. 1. About Multiple Myeloma 7 What is Multiple Myeloma ? 8 What causes Multiple Myeloma ? 10 Are there different types of Myeloma ? 10 What are the symptoms of Myeloma ? 12 Can Myeloma be cured? 14 Key points NCCN Guidelines for Patients . Multiple Myeloma , 2022 6. 1 About Multiple Myeloma What is Multiple Myeloma ? Multiple Myeloma is a rare blood cancer that usually starts inside bones, often causing pain and fractures. While there's no cure yet, new treatments every year are giving people more hope and more years to live.

6 What is cancer? Cancer is a disease where cells the What is Multiple Myeloma ? building blocks of the body grow out of control. This can end up harming the Multiple Myeloma (also simply called Myeloma ). body. There are many types of cells in is a rare type of blood cancer that develops in the body, so there are many types of bones and other areas of the body. It results when certain cancerous cells called Myeloma cancers. cells build up in the bone marrow. Bone Cancer cells don't behave like normal marrow is the soft, sponge-like center inside cells. Normal cells have certain rules. most bones. It's where most blood cells are Cancer cells don't follow the rules. made. Cancer cells develop genetic errors In someone with Myeloma , the Myeloma cells (mutations) that cause them to make become so numerous in the bone marrow that many more cancer cells. The cancer they can crowd out healthy blood cells, causing cells crowd out and overpower normal harmful blood problems.

7 This oversupply of cells. Myeloma cells also reduces the number of healthy blood cells in the body, which can Cancer cells avoid normal cell death. increase the risk of infections. In addition, They can spread to other areas of the Myeloma cells release large amounts of body. They can replace many normal Myeloma proteins, which can impair bodily cells and cause organs to stop working. functions (like kidney function). Myeloma cells can also destroy bone tissue, causing high Scientists have learned a great deal calcium levels, bone pain, weakened bones, about cancer. As a result, today's and bone fractures. treatments work better than treatments in the past. Also, many people with cancer When Myeloma cells build up in bone marrow, have more than one treatment choice. they can form tumors called plasmacytomas. Rarely, some people develop only one tumor, which is called solitary plasmacytoma. More often, people may have Multiple plasmacytomas in different bones or areas of the body, which is why it's called Multiple Myeloma .

8 NCCN Guidelines for Patients . Multiple Myeloma , 2022 7. 1 About Multiple Myeloma What causes Multiple Myeloma ? Older age (age 65 and over) greatly increases Like other healthy cells, plasma cells grow and the risk of developing Multiple Myeloma . It's then divide to make new cells. New cells are also more common in men than in women, made as the body needs them. When plasma twice as common in Black people than in White cells grow old or get damaged, they die a people, and two to three times more common in normal and natural process. But somewhere first-degree relatives. along the line, genetic alterations occur that turn a plasma cell into a Myeloma cell. Myeloma cells, unlike healthy plasma cells, What causes Multiple make more and more new Myeloma cells Myeloma ? that aren't needed and don't die quickly when old or damaged. The Myeloma cells Many people wonder why they got cancer. continue to make millions of identical copies of Doctors don't know exactly what causes themselves.

9 They can spread throughout the cancerous Myeloma cells to form. What bone marrow or grow into a clump (mass) in doctors do know is that myelomas and one or more spots outside of the bone marrow. other cancers often start with abnormalities These masses can destroy the bone around (mutations) in the cells, which allow the cells them as they grow. to grow unchecked. These types of mutations aren't typically passed down in families Myeloma cells, like normal plasma cells, also (hereditary mutation). They happen on their make antibodies. But the antibodies made by own and only in tumor cells. Still, you may Myeloma cells are all copies of a single type have a higher risk for Myeloma if another of antibody. These are called monoclonal family member also had Myeloma . proteins, M-proteins, or M-spike. Myeloma cells make M-proteins without control and not The mutation occurs in the cells' genes. Genes in response to a specific germ in the body. carry the instructions in cells for making new M-proteins don't help to fight infections.

10 Cells and for controlling how cells behave. A. gene mutation can turn helpful, normal plasma cells into harmful, cancerous Myeloma cells. What are plasma cells? Plasma cells come from white blood cells called B cells, a type of immune cell. Plasma cells fight infection and disease. They do this by making antibodies (also called immunoglobulins [Ig]). Antibodies are proteins released into blood and other body fluids that help your body find and kill germs. NCCN Guidelines for Patients . Multiple Myeloma , 2022 8. 1 About Multiple Myeloma What causes Multiple Myeloma ? Where do Myeloma cells come from? When antigens (such as germs) invade the body, healthy white blood cells turn into plasma cells, which release germ-fighting antibodies to stop infection and disease (left). But in Multiple Myeloma (right), a DNA mutation causes white blood cells to become Multiple Myeloma cells. Multiple Myeloma cells can multiply and spread rapidly. They also produce a lot of antibodies, called M-proteins, which can build up in the bone marrow and cause damage.