NCCN Updates Clinical Practice Guidelines for Multiple Myeloma

The National Comprehensive Cancer Network (NCCN) recently published updated recommendations regarding the management of multiple myeloma (MM) which provide recommendations for diagnosis, initial workup, treatment, follow-up, and supportive care for patients with various plasma cell neoplasms, including MM. The updated NCCN Guidelines Insights also emphasize some of the critical updates/changes specific to recommendations for newly diagnosed transplant-eligible and transplant-ineligible candidates, maintenance, and previously treated MM, and principles of management of venous thromboembolism (VTE; J Natl Compr Canc Netw. 2022; 20(1):8-19. doi:10.6004/jnccn.2022.0002).

For Version 3.2022, the panel added new regimens for both transplant-eligible as well as transplant-ineligible patients with newly diagnosed MM. The bortezomib/cyclophosphamide/dexamethasone regimen was moved from the “preferred” category to “useful in certain circumstances” for transplant candidates. The panel added the 4-drug regimen daratumumab/carfilzomib/lenalidomide/dexamethasone for transplant-eligible patients with newly diagnosed MM to the list of regimens in the “useful in certain circumstances” category. The panel also added the modified bortezomib/lenalidomide/dexamethasone (VRd-lite) for nontransplant patients.

With regard to maintenance therapy, the panel has now included lenalidomide/bortezomib with dexamethasone as a maintenance therapy option for transplant-eligible patients.

Based on new data, treatment options for previously treated MM, isatuximab-irfc/carfilzomib/dexamethasone and daratumumab/pomalidomide/dexamethasone were moved from the other recommended regimens to preferred regimens for early relapses (1–3 prior therapies).

The panel has also included daratumumab/pomalidomide/dexamethasone as a category 1, preferred treatment option for patients with relapsed/refractory  MM who have received at least 2 prior therapies, including an immunomodulatory drug (IMiD) and a protease inhibitor (PI).

Version 3.2022 also includes recommendations specific to VTE risk assessment and VTE prophylaxis for patients with MM.

For a complete list of updates to the 3.2022 version, please visit, https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1445