"Multiple myeloma is an incurable blood cancer that affects more than 20,000 people in the U.S. each year," says lead author Joseph Mikhael, M.D. a hematologist at 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."
Dr. Mikhael says 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.
Among the guidelines:
- A strong recommendation to enroll patients in clinical trials as the first option for therapy or supportive care.
- Separating patients by risk into three groups to make the most of new drug therapy: high risk, intermediate risk and low risk. Previous guidelines included only two groups: high risk and standard risk.
- Adding factors to assess the risk the multiple myeloma poses to the patient, including use of gene expression profiling to help identify patients with high-risk disease.
- Greater emphasis on delaying stem cell transplants to take advantage of improved chemotherapy, resulting in better responses.
- Maintenance therapy using drugs such as lenalidomide and bortezomib that balance benefit with short- and long-term toxicity.