NCCN Guidelines for Patients® | Multiple Myeloma - page 50

48
NCCN Guidelines for Patients
®
Multiple Myeloma, Version 1.2014
4
Treatment guide
Active multiple myeloma
Chart 4.4.2
shows the follow-up tests that are
recommended to check how well primary treatment
is working. It also shows the next treatments that
are recommended after primary treatment, based on
results of the follow-up tests.
Follow-up tests
Follow-up tests are recommended after 2 cycles of
primary treatment for active myeloma. These tests are
used to check for a treatment response—an outcome
or improvement related to treatment.
Follow-up tests
Test results
Next treatment
• Bone marrow aspiration and biopsy as needed
Blood tests
• CBC
• BUN, creatinine, and calcium
• Serum quantitative immunoglobulins
• SPEP and SIFE
• Serum free light chain assay as needed
Urine tests
• Total protein
• UPEP and UIFE
Imaging tests
• Bone survey every year or for symptoms
• MRI as needed
• PET/CT scan as needed
Chart 4.4.2 Follow-up after primary treatment (no transplant)
Treatment
response
No treatment
response
Continue primary treatment
until best response, then
observation + maintenance
treatment
Additional treatment
on or off clinical trial
Maintenance treatment options:
Preferred regimens
Bortezomib,
Lenalidomide, or
Thalidomide
Other regimens
Bortezomib + prednisone,
Bortezomib + thalidomide,
Interferon,
Steroids, or
Thalidomide + prednisone
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