NCCN Guidelines for Patients® | Multiple Myeloma

43 NCCN Guidelines for Patients ® : Multiple Myeloma, 2019 4 Treatment guide Active (symptomatic) multiple myeloma Active (symptomatic) multiple myeloma Guide 5 shows the primary treatment options and follow-up tests for multiple myeloma that is causing symptoms. 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 done to see if 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. Your age and other current health problems are also important. 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) • Bisphosphonates or denosumab • Supportive care 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 as needed • Serum FLC assay as needed • Bone survey or whole-body low-dose CT scan as needed • Bone marrow aspirate and biopsy at relapse with FISH • Whole-body or skeletal MRI or whole-body FDG 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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