NCCN Guidelines for Patients® | Multiple Myeloma - page 47

NCCN Guidelines for Patients™: Multiple Myeloma
Version 1.2012
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5.4 Active multiple myeloma
Part 5.4.1 describes treatment for active myeloma that can’t be treated with a stem cell
transplant. Primary treatment includes chemotherapy, targeted therapy, and steroids given
alone or in combination. Compared to ‘other’ regimens, ‘preferred’ regimens work better,
have less serious side effects, or both. After two cycles of primary treatment, you will have
follow-up tests to check your response to treatment.
Along with primary treatment, adjunctive treatment is recommended. Bone damage from
myeloma is very common, so bisphosphonates are recommended. If your primary treatment
consists of thalidomide or lenalidomide, blood thinners are suggested. Other adjunctive
treatment is given as symptoms of myeloma or treatment appear.
Next steps:
See Part 5.4.2 for a list of follow-up tests after primary treatment for active myeloma.
5.4.1 Primary treatment alone (no transplant)
Adjunctive treatment
Primary treatment
Preferred regimens
Lenalidomide/low-dose dexamethasone,
Melphalan/prednisone/lenalidomide, or
Other regimens
Liposomal doxorubicin/vincristine/
Melphalan/prednisone, or
Bisphosphonates for bone health
As needed:
Control of bone pain with drugs, radiation
therapy, or surgery,
Drug treatment for high calcium levels,
Plasmapheresis for hyperviscosity,
Erythropoietin for anemia,
Vaccines and treatments for infections,
Liquids and possible plasmapheresis to
prevent kidney damage, and
Blood thinners to prevent blood clots
See pages 24 – 31
for more information
on treatment.
Adjunctive treatment:
Medicine for symptoms
of myeloma
that help improve bone
strength and prevent loss
of bone mass
A drug
used to treat low red blood
cell counts
A process
that removes M-proteins
from the blood
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