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UPDATES: NCCN Guidelines® and NCCN Compendium®

NCCN Flash Update sent November 8, 2013

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Multiple Myeloma. These NCCN Guidelines® are currently available as Version 2.2014.

  • Smoldering (asymptomatic) myeloma (MYEL-3):
    • Added the following footnote: "A relatively small randomized prospective study has shown benefit of early treatment with lenalidomide and dexamethasone for a subset of patients with smoldering myeloma with certain high-risk features predictive for early clinical progression (Mateos MV, Hernandez M, Giraldo P, et al. Lenalidomide plus dexamethasone for high-risk smoldering multiple myeloma. N Engl J Med 2013;369:438-447). However, the high-risk criteria specified in the study are not in common use. Alternative criteria are under investigation (Dispienzeri A, Kyle R, Katzmann J, et al. Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma. Blood 2008;111:785-789). The NCCN panel strongly recommends enrolling eligible smoldering myeloma patients with high-risk criteria in clinical trials."
  • Definition of Multiple Myeloma (MYEL-B)
    • Modified the table for Smoldering (Asymptomatic) Myeloma to include the following characteristics:
      • IgG ≥ 3 g/dL; IgA > 1 g/dL or Bence-Jones protein >1 g/24h

 

  • Added the following footnote: "The understanding of smoldering (asymptomatic) myeloma is evolving rapidly. Some studies have shown that patients with certain characteristics including IgG levels of > 3 g/dL, IgA of > 2 g/dL, or urinary Bence Jones protein of > 1 g/24 hours (Mateos MV, Hernandez M, Giraldo P, et al. Lenalidomide plus dexamethasone for high-risk smoldering multiple myeloma. N Engl J Med 2013;369:438-447) or abnormal free light chain ratios (Dispienzeri A, Kyle R, Katzmann J, et al. Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma. Blood 2008;111:785-789), have an increased risk of progression to active (symptomatic) myeloma. It is also increasingly recognized, that the classical definition of smoldering myeloma using certain tests such as plain x-rays is outdated. Efforts to modify these criteria and reclassify some patients previously classified as 'asymptomatic' to having 'active disease' are underway."
  • The Discussion section has been updated to reflect the changes in the algorithm.

 

*For your reference, the announcement of the previous update (Version 1.2014) to the NCCN Guidelines for Multiple Myeloma, distributed on September 10, 2013, is included below:

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Multiple Myeloma. These NCCN Guidelines® are currently available as Version 1.2014.

  • Follow-up/Surveillance after primary treatment of osseus, extraosseus plasmacytoma, and multiple myeloma (MYEL-2 and MYEL-3): Changed "calcium" to "corrected calcium."
  • Post-autologous stem cell transplant, after achieving a response or stable disease (MYEL-5):
    • Added "± maintenance therapy" following second tandem transplant.
    • Added a new footnote: "Retrospective studies suggest a 2-3 y minimum length of remission for consideration of a second autologous stem cell transplant for salvage therapy (category 2B)."
    • Added "additional autologous stem cell transplant" as an option along with salvage therapy on or off clinical trial

 

  • For progressive disease post-autologous stem cell transplant (MYEL-5):
    • Removed "additional autologous stem cell transplant" as an option
  • For relapsed disease (MYEL-6):
    • Removed "additional autologous stem cell transplant" as an option for progressive disease after an autologous stem cell transplant

 

  • Myeloma Therapy (MYEL-D, page 1 of 2)
    • Added the following maintenance therapy options under "other regimens:"
      • Bortezomib + prednisone (category 2B)
      • Bortezomib + thalidomide (category 2B)
  • The Discussion section has been updated to reflect the changes in the algorithm.

For the complete updated versions of the NCCN Guidelines, the NCCN Drugs & Biologics Compendium (NCCN Compendium®), and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit NCCN.org.

To access the NCCN Biomarkers Compendium™, please visit NCCN.org/biomarkers.

To view the NCCN Guidelines for Patients®, please visit NCCN.org/patients.

Free NCCN Guidelines apps for iPad and Android tablets are now available! Visit NCCN.org/apps