Joint clinical practice guidelines have been developed by the American Society of Clinical Oncology and Cancer Care Ontario for treating patients with newly diagnosed and relapsed multiple myeloma which include consensus recommendations on:
- Criteria to assess eligibility for autologous stem-cell transplant (SCT)
- Options for initial therapy before transplant
- Options for post-transplant therapy
- Factors influencing first choice of relapse therapy
Recommendations to assess patients for transplant-eligibility include:
- Patients should be referred to a transplant center early in the course of care to determine transplant eligibility.
- Chronologic age and renal function should not be the sole criteria used to determine SCT eligibility.
- Up-front SCT should be offered to all transplant-eligible patients.
- Delayed initial SCT may be considered in select patients
- Tandem autologous SCT should not be routinely recommended.
- Allogeneic transplantation may be considered in select high-risk patients or in the context of a clinical trial, but not routinely recommended.
To develop the guidelines, a panel of myeloma experts analyzed 124 published, peer-reviewed systematic reviews, meta-analyses, randomized controlled trials, and phase II studies. Outcomes evaluated included survival, progression-free survival, response rate, and quality of life.
The expert panel acknowledged the increasing complexity of treatment decisions and offer the guidelines on best practices in managing myeloma and proving care at the highest level.