45 NCCN Guidelines for Patients ® : Multiple Myeloma, 2018 4 Treatment guide Active (symptomatic) multiple myeloma Adjunctive treatment Along with primary treatment for myeloma, you will also receive adjunctive treatment. It is given to “assist” the primary treatment, such as by improving its safety or how well it works. For myeloma, adjunctive treatment includes supportive care to manage the symptoms of myeloma and side effects of myeloma treatment. Recommended adjunctive treatments can include: Bisphosphonates for bone health (recommended for all patients) Drugs, radiation therapy, or surgery for bone pain Drug treatment for high calcium levels Plasmapheresis for hyperviscosity Erythropoietin for anemia Vaccines and treatments for infections Blood thinners to prevent blood clots Liquids and possible plasmapheresis to reverse kidney damage Adjunctive treatments are recommended based on the symptoms and side effects you have. Thus, you may not need every adjunctive treatment listed. Bone damage from myeloma is very common. Therefore, bisphosphonates may be recommended. Drugs such as thalidomide, lenalidomide, and pomalidomide can cause serious blood clots. If these drugs are part of the primary treatment given, then blood thinners may be recommended. Blood thinners are medicines that thin out blood to treat or lower the risk of blood clots. Other adjunctive treatments may be given as symptoms of myeloma or side effects of myeloma treatment appear. For more details about each adjunctive treatment, read page 33 in Part 3. Follow-up tests Certain follow-up tests should be given after each cycle of primary treatment for active myeloma. These tests are used to check for a treatment response. Many of the tests used for follow-up will be the same as those used to confirm (diagnose) myeloma. A bone marrow aspiration and biopsy may be done to check if plasma cell levels in the bone marrow have decreased. A CBC will show if the number of blood cells is low for each blood cell type. Blood chemistry tests check if certain substances in your blood are too low or too high. Tests of BUN, creatinine, and calcium levels help check 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 details about each test.) Next steps After primary treatment, see Guide 6 on page 47 for your next treatment options based on the results of the follow-up tests in Guide 5.