NCCN Guidelines for Patients® | Multiple Myeloma - page 48

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NCCN Guidelines for Patients™: Multiple Myeloma
Version 1.2012
Who should read this booklet?
5.4 Active multiple myel ma
Part 5.4.2 describes follow-up care after primary treatment
for active myeloma. After two cycles, your treatment
response will be checked by repeating the blood and urine
tests in Part 5.1 to see if M-protein levels are falling as well
as tests to see if plasma cell levels in bone marrow are
falling. Symptoms of myeloma, such as anemia and bone
damage, will also be assessed. See page 45 for possible
treatment responses.
If you had a treatment response, primary treatment may be
continued until no further treatment response is seen with
follow-up tests. Afterward, you may be given maintenance
treatment or your doctor may decide that treatment is
completed. In either case, you will receive regular follow-up
tests to check the status of the cancer.
Next steps:
If follow-up tests show that there was no response to
primary treatment, see Part 5.4.3. Part 5.4.3 also covers
treatments for a progression or relapse of myeloma
following maintenance therapy or observation.
5.4.2 Care after primary treatment
• Blood tests:
▪▪ CBC
▪▪ BUN, creatinine, calcium
▪▪ Serum quantitative immunoglobulins, SPEP, and SIFE
▪▪ Serum free light chain assay as needed
• Urine tests:
▪▪ Total protein
▪▪ UPEP
▪▪ UIFE
• Imaging tests:
▪▪ Bone survey every year or for symptoms
▪▪ MRI as needed
▪▪ PET/CT scan as needed
• Bone marrow aspiration and biopsy as needed
Follow-up tests and treatment
Preferred regimens
Bortezomib,
Lenalidomide, or
Thalidomide
Other regimens
Interferon,
Steroids, or
Thalidomide + prednisone
Maintenance treatment
Observation
If treatment
response,
continue primary
treatment until
best response
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