In this context, the authors note that PET/CT has recently been shown to be sensitive and specific in the assessment of extramedullary disease.

Although treatment selection for patients with extramedullary multiple myeloma is limited by the absence of clinical trials focused on this population, the high-risk nature of extramedullary multiple myeloma warrants treatment with an intensive regimen.

Specifically, the authors recommended upfront treatment with triplet induction therapy including a proteasome inhibitor and an immunomodulatory followed by autologous hematopoietic stem cell transplantation (HSCT) with high-dose melphalan conditioning, triplet consolidation therapy, and maintenance therapy with lenalidomide for patients who are HSCT candidates. For those not eligible for HSCT, standard-of-care triplet therapy with an alkylating agent and proteasome inhibitor or continuous lenalidomide with dexamethasone is recommended.

Reference

Morales-Chacón K, Bourlon MT, Martínez-Baños D, Delgado-de-la-Mora J, Bourlon C. Multiple myeloma with extramedullary disease: a challenging clinical dilemma. Oncology (Williston Park). 2019;33:149-151.