NCCN Guidelines for Patients® | Multiple Myeloma

44 NCCN Guidelines for Patients ® : Multiple Myeloma, 2019 4 Treatment guide Active (symptomatic) multiple myeloma Primary treatment Your primary treatment options depend on whether or not a stem cell transplant might be part of the overall treatment. Some drugs can cause severe damage to healthy cells in your bone marrow. This can make it more difficult to harvest stem cells for a transplant. Thus, some drugs are not recommended for primary treatment if you might have a stem cell transplant later. If your doctor thinks you might have a stem cell transplant, he or she would harvest stem cells after 3 to 6 cycles of treatment. The goal is to harvest enough for 2 possible transplants. For active myeloma, the primary treatment options are also split into 3 groups—preferred regimens, other regimens, and those used for some patients. Compared to “other” regimens, “preferred” regimens have been proven to work better and/or have less severe side effects. The regimens in the “other options” or “useful in some patients” categories have not yet undergone sufficient testing or have been proven to be less effective than the “preferred” regimens. (See Part 3 on page 24 for more details about each type of myeloma treatment.) Ask your Primary treatment for transplant patients Preferred options Other options Useful for some patients • Bortezomib/lenalidomide/ dexamethasone • Bortezomib/doxorubicin/ dexamethasone • Bortezomib/dexamethasone • Bortezomib/cyclophosphamide/ dexamethasone • Carfilzomib/lenalidomide/ dexamethasone • Bortezomib/thalidomide/ dexamethasone • Ixazomib/lenalidomide/ dexamethasone • Cyclophosphamide/lenalidomide/ dexamethasone • Lenalidomide/dexamethasone • Dexamethasone/thalidomide/ cisplatin/doxorubicin/ cyclophosphamide/etoposide/ bortezomib Primary treatment for non-transplant patients Preferred options Other options Useful for some patients • Bortezomib/lenalidomide/ dexamethasone • Carfilzomib/lenalidomide/ dexamethasone • Bortezomib/dexamethasone • Lenalidomide/low-dose dexamethasone • Carfilzomib/cyclophosphamide/ dexamethasone • Bortezomib/cyclophosphamide/ dexamethasone • Ixazomib/lenalidomide/ dexamethasone • Daratumumab/bortezomib/ melphalan/prednisone