New multiple myeloma treatment guidelines personalize therapy for patients

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New guidelines have been developed to treat recently diagnosed multiple myeloma in patients who are not participating in clinical trials. The guidelines give physicians practical, easy to follow recommendations for providing initial therapy, stem cell transplant, and maintenance therapy.

"Multiple myeloma is an incurable blood cancer that affects more than 20,000 people in the US each year," said lead author Joseph Mikhael, MD, a hematologist at the Mayo Clinic in Arizona. "Over the past decade we have made great progress in understanding the disease, developing drug therapies and 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."

Mikhael said the new guidelines will help patients with low-risk disease avoid the harsh side effects of therapy, and will reserve more intense therapy for patients with aggressive disease. The guidelines are published in the current issue of the journal Mayo Clinic Proceedings (2013;4:360-376) and represent a consensus opinion of hematologists at Mayo Clinic Cancer Center sites in Minnesota, Florida, and Arizona.

The first recommendation of the guidelines is to enroll patients in clinical trials as the first option for therapy or supportive care. The guidelines separate patients into three risk groups (low, intermediate, and high risk) to make the most of new drug therapies, whereas previous guidelines only had two risk groups, which were high and standard.

The guidelines also add factors to assess the risk multiple myeloma poses to the patient, including the use of gene expression profiling to help identify patients with high-risk disease. Greater emphasis is placed on delaying stem cell treatments to take advantage of improved chemotherapy that results in better responses. Also, the guidelines discuss the use of maintenance therapy using drugs such as lenalidomide and bortezomib that balance benefit with short- and long-term toxicity.

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