Treatment of Multiple Myeloma: ASCO and CCO Joint Clinical Practice Guideline

Abstract

PURPOSE To provide evidence-based recommendations on the treatment of multiple myeloma to practicing physicians and others. METHODS ASCO and Cancer Care Ontario convened an Expert Panel of medical oncology, surgery, radiation oncology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and some phase II studies published from 2005 through 2018. Outcomes of interest included survival, progression-free survival, response rate, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 124 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed for patients with multiple myeloma who are transplantation eligible and those who are ineligible and for patients with relapsed or refractory disease.

Treatment Journeys of Patients With Newly Diagnosed Multiple Myeloma (NDMM): Results From The Connect MM Registry

“…The Sankey plots created using data from the largely communitybased Connect MM Registry demonstrate the substantially heterogeneous therapeutic journeys of real-world patients with MM. In accordance with treatment guidelines, 11 IMiD agents and/or PIs were the mainstays of treatment in SCT and NSCT patients. In 1L and 2L settings, at least 75% of regimens received contained IMiD agents and PIs alone or in combination with other agents.…”

Challenges in the cultural adaptation of the German Myeloma Patient Outcome Scale (MyPOS): an outcome measure to support routine symptom assessment in myeloma care

“…Patients were approached individually, by their treating physician, and via an information leaflet in outpatient clinics. Inclusion criteria were selected in order to approach patients in need of myeloma treatment: confirmed diagnosis of multiple myeloma (MM) Salmon & Durie stage III, high-risk smoldering MM with positive CRAB-criteria (hyperCalcemia, Renal failure, Anemia, Bone lesions) [6], and any other MM stage triggering supportive therapy. Patients had to be age 18 years or older, sufficiently fluent in written and spoken German, and had to have the capacity to give informed, written consent.…”

“…Haematological cancers and multiple myeloma (MM) in particular exemplify this changing face of cancer as conditions whose management resembles that of a chronic illness, with recurrent treatment patterns followed by maintenance therapy [4,5]. MM is an incurable cancer of the bone marrow characterised by bone destruction, bone marrow failure with anaemia, immune deficiency, and renal insufficiency [6]. It belongs to the heterogeneous group of plasma cell dyscrasias, which vary from asymptomatic forms to malignant disease with severe endorgan damage and high patient morbidity [7].…”

Once- versus twice-weekly carfilzomib in relapsed and refractory multiple myeloma by select patient characteristics: phase 3 A.R.R.O.W. study subgroup analysis

“…Clinical practice guidelines from the National Comprehensive Cancer Network, American Society of Oncology, and Cancer Care Ontario recommend doublet and triplet regimens as treatment options for patients with previously treated MM 41,42 . In randomized trials, carfilzomib-and daratumumab-based triplets have improved PFS, ORR, and/or OS in relapsed and/or refractory MM patients relative to doublet therapies; however, triplet therapies were also associated with higher rates of toxicity in these studies 17,18,[43][44][45][46] .…”

“…In randomized trials, carfilzomib-and daratumumab-based triplets have improved PFS, ORR, and/or OS in relapsed and/or refractory MM patients relative to doublet therapies; however, triplet therapies were also associated with higher rates of toxicity in these studies 17,18,[43][44][45][46] . Therefore, patients with lower tolerance for increased toxicity, higher comorbidity burden, and/or frail status may not be suited for triplet therapies 42 . Comparisons of once-weekly Kd70 mg/m 2 with currently available data from triplet combination studies are challenging, given differences in patient population (e.g., prior therapy, sensitivity to IMiDs and/or PIs, baseline creatinine clearance) and stratification of subgroups 17,20,22,[43][44][45][46][47] .…”