NCCN Guidelines for Patients® | Multiple Myeloma

39 NCCN Guidelines for Patients ® : Multiple Myeloma, 2019 4 Treatment guide Treatment options This chapter is a guide through the treatment options for people with multiple myeloma. This information is based on treatment guidelines written by NCCN experts in multiple myeloma. These treatment guidelines list options for people with myeloma in general. Your doctors may suggest other treatment for you based on your health and personal wishes. Fully discuss your treatment options with your doctor. There are many treatment options for myeloma. The type of treatment, and when it should start, depends on a number of factors. But, supportive care— adjunctive treatment—is an important part of the overall treatment for all patients. Treatment options The treatment options in this chapter are grouped by the extent of the cancer and severity of its symptoms. A solitary plasmacytoma is when there is only one mass of myeloma cells. Multiple myeloma is when myeloma cells are found in many sites throughout the bone marrow. Multiple myeloma is divided into two main groups. The number of abnormal plasma cells (myeloma cells) in the bone marrow is a key factor used to define these groups. Other factors are also important. Smoldering (asymptomatic) myeloma is defined as having: † † Presence of M-protein in the blood or † † An increased level of light chains (Bence Jones protein) in the urine and/or † † 10% to 59% abnormal plasma cells in the bone marrow (when 10 to 59 out of every 100 cells in the bone marrow are plasma cells) and † † No other myeloma symptoms such as kidney damage, bone damage, anemia, or increased levels of calcium in the blood or features of active myeloma as shown below Active (symptomatic) myeloma is defined as having: † † At least 10% abnormal plasma cells in the bone marrow or a plasmacytoma confirmed by biopsy and † † One or more of the following myeloma-defining events: • At least 60% abnormal plasma cells in the bone marrow—60 or more cells out of every 100 cells in the bone marrow are plasma cells • An increased level of calcium in the blood • Kidney damage • A low number of red blood cells (anemia) • Presence of lytic bone lesions or 2 or more lesions in the bone marrow • A serum free light chain ratio of ≥100