NCCN Guidelines and Compendium Updated
Flash Update Sent July 29, 2011
NCCN has published updates to the NCCN Guidelines and the NCCN Compendium® for Multiple Myeloma. These NCCN Guidelines are currently available as Version 1.2012.
- The list of tests for initial diagnostic workup and follow-up/surveillance has been updated. “Multi-parameter flow cytometry as clinically indicated” is now added to the list of follow-up/surveillance tests for smoldering (asymptomatic) myeloma.
- Stem cell transplant: Footnote “h” has been updated with new references. Added footnote “l”: Additional autologous transplant on or off clinical trial is an option depending on the time interval between the preceding stem cell transplant and documented progression.
- The primary therapy and maintenance regimens on page titled “Myeloma Therapy” have been classified either as “preferred regimens” or “other regimens” and all the information is now listed in a table format.
- Primary therapy for transplant candidates: Bortezomib/lenalidomide/dexamethasone has been changed to category 2A from a category 2B.
- Maintenance therapy: Bortezomib was added to the list of “preferred regimens” for maintenance therapy.
- Salvage therapy: A new regimen bortezomib in combination with dexamethasone/thalidomide/cisplatin/doxorubicin/cyclophosphamide/etoposide (VTD-PACE) was added to the list of salvage regimens. Bendamustine has been changed to a category 2A from a category 2B. Bortezomib/lenalidomide/dexamethasone regimen has been changed to a category 2A from a category 2B. The panel now recommends single agents, lenalidomide and thalidomide as salvage therapy, only for steroid-intolerant individuals (information in a new footnote #6). Cyclophosphamide/vincristine/doxorubicin/dexamethasone (C-VAD) regimen and single agent dexamethasone were taken off the list of salvage regimens.
- Adjunctive treatment: The panel now recommends bisphosphonate therapy for all patients receiving primary myeloma therapy. Previously it was recommended in all myeloma patients with documented bone disease. For treatment of hypercalcemia, if bisphosphonates is chosen, the panel prefers using zoledronic acid.
For the complete updated version of these and all NCCN Guidelines, visit NCCN.org.