NCCN Guidelines for Patients® | Multiple Myeloma

52 NCCN Guidelines for Patients ® : Multiple Myeloma, 2018 4 Treatment guide Active (symptomatic) multiple myeloma Guide 8 shows the treatment options that may be used after an autologous stem cell transplant. An autologous stem cell transplant is a treatment in which your own blood stem cells are removed, stored, and then returned. The next treatment options depend on how the myeloma responded to the transplant. A treatment response is an outcome or improvement caused by treatment. See page 46 to read about the types of treatment responses. If tests show a treatment response or stable disease, you have two treatment options to choose from. The first option is to receive maintenance therapy. Maintenance therapy is medicine given in a lower dose or less often to keep (maintain) good results of prior treatments. Another option is to receive treatment in a clinical trial. If tests show progressive disease after any of the treatments described above, you have a few more treatment options to choose from. The first option is to receive additional treatment. Additional treatment is given after prior treatments are not working and the cancer remains or continues to grow. Another option is to receive treatment in a clinical trial with or without another autologous stem cell transplant. A treatment response lasting at least 2 to 3 years prior to progression is suggested for consideration of another autologous stem cell transplant. If this is not an option, your doctor may also consider an allogeneic stem cell transplant. If tests show progressive disease, then you have a few treatment options to choose from. One option is to receive additional treatment. Another option is to receive treatment in a clinical trial. The other option is to receive an allogeneic stem cell transplant. If tests show progressive disease during or after additional treatment, then palliative care may be recommended. Palliative care is given to relieve symptoms of cancer and side effects of cancer treatment. It doesn’t aim to treat the cancer, but aims to improve quality of life.   Guide 8. Treatment after autologous stem cell transplant Test results Next treatment options Next options for progressive disease Treatment response or stable disease ª • Maintenance therapy • Clinical trial ª • Therapy for previously treated myeloma • Clinical trial ± additional autologous stem cell • Allogeneic stem cell transplant Progressive disease ª • Therapy for previously treated myeloma • Clinical trial • Allogeneic stem cell transplant

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