NCCN Guidelines for Patients® | Multiple Myeloma

43 NCCN Guidelines for Patients ® : Multiple Myeloma, 2018 4 Treatment guide Active (symptomatic) multiple myeloma Active (symptomatic) multiple myeloma Guide 5 shows the primary treatment options for multiple myeloma that is causing symptoms and follow-up tests. Myeloma that is causing symptoms is called active myeloma or symptomatic myeloma. Primary treatment is the first treatment given to try to rid your body of cancer. Primary treatment for active myeloma includes systemic therapies. Systemic therapy travels in your body to treat more than one area of cancer. This type of treatment includes chemotherapy, targeted therapy, and steroids. These drugs may be given alone or in combination. Follow-up tests are usually done after 1 to 2 cycles of treatment to see whether or not the treatment is working or if the disease is progressing (getting worse). Treatment for active myeloma may or may not include a stem cell transplant. A stem cell transplant is not a good treatment option for everyone. Your doctor will look at a number of factors to decide if it might be the right choice for you. Some key factors include the health of your liver, kidneys, and heart. Guide 5. Primary treatment and follow-up for active (symptomatic) myeloma Cancer type Primary treatment Follow-up tests Active (symptomatic) multiple myeloma ª • Myeloma therapy (see primary treatment lists for transplant and non- transplant patients on page 44) • Bisphophonates and adjunctive treatment as needed ª • CBC with differential and platelet count • Blood chemistry tests: creatinine and corrected calcium • Serum quantitative immunoglobulins, SPEP, and SIFE as needed • 24-hour urine for total protein • UPEP and UIFE • Serum FLC assay as needed • Bone survery or whole-body low- dose CT scan as needed • Bone marrow aspirate and biopsy at relapse with FISH • Whole-body or skeletal MRI as needed • PET/CT scan as needed • Assess for stem cell transplant ◦◦ Refer to experts at stem cell transplant center ◦◦ Harvest stem cells (consider for 2 transplants)

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