The National Comprehensive Cancer Network (NCCN) released its 2016 Clinical Practice Guidelines in Oncology for Multiple Myeloma, which includes several new treatment options and broadens the management of patients with several plasma cell dyscrasias, including solidary plasmacytoma, smoldering myeloma, multiple myeloma (MM), systemic light chain amyloidosis, and WaldenstrÃ¶m macroglobulinemia.
The definition of patients with active myeloma is expanded to include patients with:
- >60% bone marrow plasmacytosis
- >100-fold free light chain ratio
- >1 bone lesion on positron emission tomography or computed tomography of magnetic resonance imaging scanning
Using the revised International Staging System, the NCCN guidelines now include cytogenetics to define prognosis following treatment, which includes serum lactate dehydrogenase and high-risk chromosomal abnormalities (defined by fluorescence in situ hybridization) to the serum albumen and beta 2 microglobulin.
The updated guidelines also include, for the first time, the following treatment options for relapsed/refractory MM:
- Carfilzomib, lenalidomide, dexamethasone combination therapy
- Ixazomib, lenalidomide, dexamethasone combination therapy
- Elotuzumab with lenalidomide and dexamethasone
- Pomalidomide plus low-dose dexamethasone
- Pomalidomide plus carfilzomib
For both HCT-eligible and transplant-ineligible patients, the triplet combination therapy of lenalidomide, bortezomib, and dexamethasone is included as Category 1 treatment for initial MM. Maintenance therapy following induction is also considered "standard practice" whether or not the patient proceeds to transplant.
Source: Anderson KC, Alsina M, Atanackovic D. NCCN Guidelines Insights: Multiple myeloma, Version 3.2016. J Natl Compr Canc Netw. 2016;14:389-400.