NCCN Guidelines for Patients® | Multiple Myeloma - page 48

NCCN Guidelines for Patients
Multiple Myeloma, Version 1.2014
Treatment guide
Active multiple myeloma
4.4 Active multiple myeloma
Part 4.4 explains the recommended treatments for
multiple myeloma that is causing symptoms, called
active myeloma. Treatment for active myeloma may
or may not include a stem cell transplant. When
deciding if a transplant is a good option for you, your
doctor will consider a number of factors. This includes
the health of your liver, kidneys, and heart, as well as
your age and other health problems.
If your treatment will not include a stem
cell transplant, see Chart 4.4.1 (below) for
recommendations. If your treatment will include a
stem cell transplant, see Chart 4.4.4 on page 51 for
Primary treatment
Adjunctive treatment
Preferred regimens
Lenalidomide/low-dose dexamethasone,
Melphalan/prednisone/lenalidomide, or
Other regimens
Liposomal doxorubicin/vincristine/dexamethasone,
Melphalan/prednisone, or
Chart 4.4.1 Primary treatment alone (no transplant)
Bisphosphonates for bone health, and
As needed:
Drugs, radiation therapy, or surgery for bone pain,
Drug treatment for high calcium levels,
Plasmapheresis for hyperviscosity,
Erythropoietin for anemia,
Vaccines and treatments for infections,
Blood thinners to prevent blood clots, and
Liquids and possible plasmapheresis to prevent
kidney damage
Chart 4.4.1
shows the recommended primary and
adjunctive treatment for active myeloma that can’t be
treated with a stem cell transplant. Primary treatment
is the first treatment given to rid your body of cancer.
It includes systemic therapies such as 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. (See Part 3 on page 24 for more
details about each type of myeloma treatment.)
Along with primary treatment, you will also receive
adjunctive treatment to manage the symptoms of
myeloma and side effects of myeloma treatment. A
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