The National Comprehensive Cancer Network (NCCN) treatment guidelines for multiple myeloma still promote the use of supportive care as a critical component of care.

Shaji K Kumar, MD, Mayo Clinic Cancer Center, presented the updates at the NCCN 23rd Annual Conference (March 22-24, 2018; Orlando, FL).

Dr Kumar explained that the NCCN’s myeloma panel categorized treatment regimens into three categories–preferred treatments, other recommended treatments, or treatments that are useful under certain circumstances– and that the updated guidelines provide treatment guidance based on results from clinical trials, relative efficacy and toxicity, comorbidities, nature of the disease, and access to treatment agents.

Dr Kumar highlighted that multiple myeloma may be asymptomatic, with no lesions or one lesion present in a magnetic resonance imaging (MRI) evaluation. If asymptomatic myeloma is identified, observation every 3 to 6 months is appropriate. Because patients are asymptomatic, and treatments are toxic with no evidence to suggest that they improve survival, no treatment is warranted. In cases of asymptomatic myeloma, risk stratification is key, and high-risk patients should be considered for clinical trials, even though treatment outside of clinical trials is not recommended.

To further this, Dr Kumar explained that according to NCCN guidelines, if myeloma becomes symptomatic, myeloma therapy, bisphosphonates or denosumab, and supportive care are indicated.

Dr Kumar emphasized a study in which patients who underwent stem cell transplantation had better outcomes than those who received bortezomib, lenalidomide, and dexamethasone alone.

For patients who are not candidates for transplant, preferred treatment regimens are bortezomib, lenalidomide, and dexamethasone; lenalidomide and low-dose dexamethasone, and bortezomib, cyclophosphamide, and dexamethasone, explained Dr Kumar. In cases of relapsed disease, therapy for previously relapsed disease, a clinical trial, or stem cell transplantation should be considered.

In his concluding remarks, Dr Kumar stressed the importance of supportive care in treating multiple myeloma. “Even though we have all these fancy, effective drugs,” said Kumar, “supportive care still plays an important role in multiple myeloma.”—Janelle Bradley