NCCN Guidelines for Patients® | Multiple Myeloma - page 50

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NCCN Guidelines for Patients™: Multiple Myeloma
Version 1.2012
5.4 Active multiple myeloma
Part 5.4.4 describes treatment for active myeloma that
might be treated with a stem cell transplant. Since a
transplant requires high-dose chemotherapy, your liver,
kidneys, and heart must be healthy. Your doctor will also
consider your age and other health problems when deciding
if a transplant is a good option.
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. These primary treatments don’t
kill stem cells since you may be having a transplant. After
two cycles, you will be given 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 5.4.5 for a list of follow-up tests after primary
treatment for active multiple myeloma.
5.4.4 Primary treatment before stem cell transplant
Preferred regimens
Bortezomib/dexamethasone,
Bortezomib/cyclophosphamide/
dexamethasone,
Bortezomib/doxorubicin/dexamethasone,
Bortezomib/lenalidomide/dexamethasone,
Bortezomib/thalidomide/dexamethasone, or
Lenalidomide/dexamethasone
Other regimens
Dexamethasone,
Liposomal doxorubicin/vincristine/dexamethasone, or
Thalidomide/dexamethasone
Adjunctive treatment
Primary treatment
Bisphosphonates for bone health
As needed:
Bone pain control 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
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