NCCN Guidelines for Patients® | Multiple Myeloma - page 54

52
NCCN Guidelines for Patients
®
Multiple Myeloma, Version 1.2014
4
Treatment guide
Active multiple myeloma
Chart 4.4.5
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 before a stem cell transplant.
These tests are used to check for a treatment
response—an outcome or improvement related to
treatment.
Follow-up tests
Test results
Stem cell transplant
• 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 4.4.5 Stem cell transplant after primary treatment
Primary
treatment
response
No primary
treatment
response
Autologous stem cell transplant, or
Allogeneic stem cell transplant
on clinical trial, or
Continue primary treatment until
best response, then observation +
maintenance treatment
Autologous stem cell transplant
Maintenance treatment options:
Preferred regimens
Bortezomib,
Lenalidomide, or
Thalidomide
Other regimens
Bortezomib + prednisone,
Bortezomib + thalidomide,
Interferon,
Steroids, or
Thalidomide + prednisone
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