NCCN Guidelines for Patients® | Multiple Myeloma - page 51

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NCCN Guidelines for Patients™: Multiple Myeloma
Version 1.2012
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5.4 Active multiple myeloma
Part 5.4.5 describes follow-up care before the stem cell
transplant. After two cycles of primary treatment, your
treatment response will be checked. See page 45 for
possible treatment responses.
You may decide to wait to have a transplant although
you had a response to primary treatment. In this case,
primary treatment may be continued until no further
treatment response is seen with follow-up tests.
Afterward, you may be given maintenance treatment
or you may start observation. During maintenance or
observation, you will receive regular follow-up tests to
check the status of the cancer.
Next steps:
See Part 5.4.6 for transplant options after primary or
maintenance treatment or observation.
5.4.5 Follow-up before transplant
Follow-up tests and 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
Preferred regimens
Bortezomib,
Lenalidomide, or
Thalidomide
Other regimens
Interferon,
Steroids, or
Thalidomide + prednisone
If treatment
response, may
continue primary
treatment until
best response
Maintenance treatment
Observation
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