Treatment algorithms for the treatment of newly diagnosed and relapsed multiple myeloma (MM) based on the best available evidence were presented in a recent publication in Blood Cancer Journal (2020;10:94. doi:10.1038/s41408-020-00359-2).
“The purpose of this current treatment algorithm is to synthesize the available data in the field and provide an evidence-based approach to the current treatment of newly diagnosed and relapsed MM,” explained the study authors.
Treatment strategies for MM were determined by age, performance status, comorbidities, and eligibility for autologous stem cell transplantation (ASCT), and risk stratification into high-risk or standard. The algorithms are based on data from randomized controlled trials, best practices based on non-randomized data, and expert opinion. They include disease assessment, treatment options, treatment options for newly diagnosed MM, treatment of relapsed MM, and treatment of smoldering MM.
The algorithm also includes disease assessment by bone marrow analysis and bone imaging in the form of a CT or MRI scan. Treatment options involve regimens that often use two or more drugs including alkylating agents, corticosteroids, immunomodulatory drugs, proteasome inhibitors, and monoclonal antibodies.
Treatment approaches for newly diagnosed MM are driven by eligibility for ACST and risk stratification. Algorithms are outlined for initial therapy in patients eligible for transplantation and patients ineligible for transplantation. Dosage and supportive care considerations are recommended. Recommendations for ASCT, tandem transplantation, and allogeneic transplantations are outlined with post-therapy recommendations included.
Since almost all MM patients relapse, a treatment algorithm for relapsed MM is presented and includes guidelines for the first relapse and second or higher relapse.
An approach to the management of smoldering MM is presented and includes guidelines for high-risk and low-risk SMM.
“Each algorithm has been designed to facilitate easy decision-making for practicing clinicians,” concluded the study authors. “In all patients, clinical trials should be considered first, prior to resorting to the standard of care algorithms we outline.”—Lisa Kuhns