NCCN Guidelines for Patients® | Multiple Myeloma - page 53

51
NCCN Guidelines for Patients
®
Multiple Myeloma, Version 1.2014
4
Treatment guide
Active multiple myeloma
Chart 4.4.4
shows the recommended primary and
adjunctive 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 for you.
Primary treatment is the first treatment given to rid
your body of myeloma. 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. These treatments don’t
kill stem cells since you may be having a transplant.
Along with primary treatment, you will also receive
adjunctive treatment to manage the symptoms of
myeloma and side effects of myeloma treatment.
Bone damage from myeloma is very common, so
bisphosphonates are recommended. If the primary
treatment given includes thalidomide or lenalidomide,
which can cause serious blood clots, then blood
thinners are recommended. Blood thinners are
medications that thin out blood to treat or reduce the
risk of blood clots. Other adjunctive treatments may
be given as symptoms of myeloma or side effects of
myeloma treatment appear. (See Part 3 on page 24
for details on each type of treatment.)
Next steps:
See Chart 4.4.5 for recommended
follow-up tests and stem cell transplant
options after primary treatment.
Primary treatment
Adjunctive treatment
Preferred regimens
Bortezomib/dexamethasone,
Bortezomib/cyclophosphamide/dexamethasone,
Bortezomib/doxorubicin/dexamethasone,
Bortezomib/lenalidomide/dexamethasone,
Bortezomib/thalidomide/dexamethasone, or
Lenalidomide/dexamethasone
Other regimens
Carfilzomib/lenalidomide/dexamethasone,
Dexamethasone,
Liposomal doxorubicin/vincristine/dexamethasone, or
Thalidomide/dexamethasone
Chart 4.4.4 Primary treatment before 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
+
1...,43,44,45,46,47,48,49,50,51,52 54,55,56,57,58,59,60,61,62,63,...82
Powered by FlippingBook