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New Multiple Myeloma Treatment Guidelines

Mayo Clinic recommendations aimed at reducing toxicity based on risk factors (Apr. 1)

Researchers at Mayo Clinic Cancer Centers have developed updated guidelines to treat recently diagnosed patients with multiple myeloma who are not participating in clinical trials. The guidelines give physicians practical recommendations for providing initial therapy, stem-cell transplant, and maintenance therapy. The guidelines, published in the current issue of Mayo Clinic Proceedings, represent consensus opinions of hematologists at Mayo Clinic Cancer Centers in Minnesota, Florida, and Arizona.

“Multiple myeloma is an incurable blood cancer that affects more than 20,000 people in the U.S. each year,” lead author Joseph Mikhael, MD, said. “Over the past decade, we have made great progress in understanding the disease, in developing drug therapies, and in increasing overall survival. However, as a medical community we haven’t done as good a job at optimizing therapy based on a patient’s individual risk factors."

According to Mikhael, the new guidelines will help patients with low-risk disease avoid adverse side effects of therapy and will reserve more intensive treatment for patients with aggressive disease.

The guidelines recommend that:

  • Patients should be enrolled in clinical trials as the first option for therapy or supportive care.
  • Patients should be separated by risk into three groups — high risk, intermediate risk, and low risk — to make the most of new drug therapy. Previous guidelines included only two groups: high risk and standard risk.
  • Factors should be added to assess the risk that multiple myeloma poses to the patient, including the use of gene-expression profiling to help identify patients with high-risk disease.
  • Greater emphasis should be placed on delaying stem-cell transplants to take advantage of improved chemotherapy, which may result in better responses.
  • Maintenance therapy should include drugs that balance benefit with short- and long-term toxicity, such as lenalidomide (Revlimid, Celgene) and bortezomib (Velcade, Millennium Pharmaceuticals).

Source: Mayo Clinic; April 1, 2013.

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