Expert European Panel Provides Clinical Practice Guidelines for Multiple Myeloma
Posted: Friday, April 9, 2021
On behalf of the European Hematology Association (EHA) Guidelines Committee and the European Society for Medical Oncology (ESMO) Guidelines Committee, Meletios A. Dimopoulos, MD, of the National and Kapodistrian University of Athens, and colleagues provided clinical practice guidelines for the diagnosis, treatment, and follow-up of patients with multiple myeloma. Their key recommendations were published in the Annals of Oncology.
New response categories of minimal residual disease (also known as measurable residual disease) negativity have become an alternate predictor for progression-free survival in patients receiving first-line treatment for myeloma. In addition, front-line therapies for patients with standard- or intermediate-risk smoldering multiply myeloma center on a wait and watch approach, whereas patients with high-risk smoldering multiple myeloma should be encouraged to take part in phase III clinical trials.
The recommended treatment for fit patients with newly diagnosed multiple myeloma up to age 70 who have no comorbidities is induction therapy followed by high-dose melphalan therapy with autologous stem cell transplantation (ASCT) and lenalidomide maintenance. The standard of care for the induction regimen consists of a three-drug combination that includes at least bortezomib and dexamethasone. Daratumumab improves progression-free survival when used with a triple combination, making it a new standard of care for induction before ASCT, according to the panel. The standard conditioning regimen before ASCT is high-dose melphalan. To date, there is no established standard consolidation therapy after ASCT.
Lenalidomide is considered the standard of care for maintenance therapy after ASCT. For those patients who are not eligible for ASCT, three new standards of care are the triplet bortezomib, dexamethasone, and lenalidomide; daratumumab with bortezomib, melphalan, and prednisone; and daratumumab with lenalidomide and dexamethasone.
Salvage ASCT may be an option for patients who received a triple combination induction therapy with bortezomib followed by ASCT. For patients not considered for salvage ASCT, second-line therapy should include a regimen with lenalidomide and dexamethasone. Other new options include pomalidomide with bortezomib and dexamethasone as well as daratumumab or isatuximab with carfilzomib and dexamethasone.
Disclosure: For full disclosures of the study authors, visit annalsofoncology.org.
