NCCN Guidelines for Patients® | Multiple Myeloma - page 55

53
NCCN Guidelines for Patients
®
Multiple Myeloma, Version 1.2014
4
Treatment guide
Active multiple myeloma
Many of the tests used for follow-up will be the same
as those described in Part 4.1 for diagnosis. A bone
marrow aspiration and biopsy may be done to check
if plasma cell levels in the bone marrow are falling.
A CBC will show if the number of blood cells is low
for each blood cell type. Tests of BUN, creatinine,
and calcium levels assess for symptoms of myeloma
such as kidney damage and bone damage. The other
blood tests and urine tests assess if M-protein levels
are falling. (See Part 2 on page 14 for more test
details.)
Test results and stem cell transplant
The recommended stem cell transplant options for
active myeloma are based on the response to primary
treatment. See page 45 to read about the types of
possible treatment responses.
If tests show that you had a response to primary
treatment,
then you have 3 options to choose from.
The first option is to receive an autologous stem
cell transplant. The second option is to receive an
allogeneic stem cell transplant as part of a clinical
trial. The third option is to continue primary treatment
until no further treatment response is seen and then
begin observation with the follow-up tests listed in
Chart 4.4.5. During observation, tests to check the
level of M-proteins in your blood and urine should be
done at least every 3 months. Along with follow-up
tests, you may also be given maintenance treatment.
Maintenance treatment is medicine given in a lower
dose or less frequently to “maintain” good primary
treatment results. Maintenance treatment options are
listed in the lower part of Chart 4.4.5. Once the follow-
up tests show progressive disease or relapse, you
may then receive an autologous stem cell transplant.
If tests show that you did not have a response
to primary treatment,
then the recommended
treatment option is to receive an autologous stem cell
transplant. (See Part 3 on page 27 for more details
about each type of stem cell transplant.)
For an autologous stem cell transplant, your stem
cells will be harvested after primary treatment when
the number of myeloma cells is low. Enough stem
cells must be collected for two transplants, as you
may have a tandem stem cell transplant or a second
transplant as additional treatment.
After the allogeneic or autologous stem cell
transplant, you will repeat the follow-up tests listed in
Chart 4.4.5 to assess for a treatment response. Tests
to check the level of M-proteins in your blood and
urine should be done at least every 3 months.
Next steps:
If you had an allogeneic stem cell
transplant, see Chart 4.4.6 for
recommendations. If you had an
autologous stem cell transplant, see
Chart 4.4.7 for recommendations.
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