The American Society of Clinical Oncology and Cancer Care Ontario have updated their guideline for treating multiple myeloma, a rare blood cancer.
The American Cancer Society estimates there will be 36,000 new cases of multiple myeloma and about 10,850 related deaths in 2026.
Since the guideline was last published in 2019, the two organizations assembled an expert panel to review 161 randomized trials. The revised document includes recommendations on smoldering myeloma, CAR T-cell therapy and new standard-of-care medication regimens.
Smoldering myeloma, an asymptomatic condition that often precedes multiple myeloma, has been increasing in incidence and prevalence since 2010, according to ASCO. The guideline recommends monitoring for all smoldering myeloma cases for up to three years and, for high-risk cases, daratumumab therapy.
For relapsed or refractory multiple myeloma, the expert panel said CAR T-cell therapy should be offered to eligible patients, but noted CAR T-cell therapy “may not be appropriate for patients with rapidly progressive relapsed myeloma given the time required for CAR T-cell manufacturing.”
Another new recommendation involves a quadruplet treatment: daratumumab or isatuximab combined with bortezomib, lenalidomide and dexamethasone should be offered as initial therapy for transplant-eligible patients, the guideline says.
The guideline also recommends adding daratumumab or carfilzomib to lenalidomide maintenance therapy for select patients, such as those with high-risk genetic abnormalities.
The full guideline is available in the Journal of Clinical Oncology.
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