NCCN Guidelines for Patients® | Multiple Myeloma - page 46

NCCN Guidelines for Patients
Multiple Myeloma, Version 1.2014
4.3 Smoldering multiple myeloma
Chart 4.3
shows the recommended primary
treatment options and follow-up tests for multiple
myeloma that isn’t causing symptoms. This is called
smoldering multiple myeloma. Primary treatment is
the first or main treatment given to rid the body of
Smoldering myeloma often takes months or years to
progress to active (symptomatic) myeloma. For this
reason, treatment isn’t needed right away. Joining
a clinical trial is strongly recommended for eligible
patients. Observation is another option. Observation
means that your doctor will watch for cancer growth
with regular follow-up tests. Many of the tests used
for follow-up are the same as those described in Part
4.1 for diagnosis and assessing symptoms. During
observation, follow-up tests are recommended every
3 to 6 months to check the status of the cancer. (See
Part 2 on page 14 for more details about each test.)
Next steps:
If the cancer grows and starts causing
symptoms, see Part 4.4 on page 46
for recommended treatments for active
Treatment guide
Smoldering multiple myeloma
Primary treatment
Clinical trial, or
Observation with testing every 3 to 6 months:
Blood tests
• BUN, creatinine, and calcium
• Serum quantitative immunoglobulins
• Serum free light chain assay as needed
Urine tests
• Total protein
Imaging tests
• Bone survey every year or for symptoms
• MRI as needed
• PET/CT scan as needed
Tissue tests
• Bone marrow aspiration and biopsy as
• Multiparameter flow cytometry as needed
Chart 4.3 Smoldering myeloma treatment
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