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Multiple Myeloma Guidelines Updated with Numerous Changes to the NCCN Categories of Evidence and Consensus for Induction Therapy Regimens

In the updated NCCN Multiple Myeloma Guidelines, bortezomib plus dexamethasone is now a category 1 option as induction therapy for transplant candidates. This category change from a 2B recommendation is based on updated results of the Intergroupe Francophone du Myelome (IFM) cooperative group phase III trial. Bortezomib, doxorubicin, and dexamethasone is now upgraded to category 1 from a category 2B option, as induction therapy for transplant candidates based on interim data from the HOVON-65/ GMMG-HD4 phase III trial. Bortezomib in combination with thalidomide and dexamethasone is now a category 1 option as induction therapy for transplant candidates. This is based on the updated results of a phase III trial from the GIMEMA Italian Multiple Myeloma Network.

Lenalidomide in combination with dexamethasone is now a category 1 recommendation in the NCCN Guidelines as an induction therapy option for both transplant and non-transplant candidates based on the updated results of the ECOG E4A03 phase III trial.

Older regimens, including dexamethasone as a single agent, thalidomide with dexamethasone for both transplant and non-transplant candidates, DVD (liposomal doxorubicin, vincristine, and dexamethasone) for transplant candidates, and VAD (vincristine, doxorubicin, and dexamethasone) for non-transplant candidates, that were previously category 2A recommendations are now category 2B.