ASCO GUIDELINES Bundle

Multiple Myeloma Treatment

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5 ➤ Physicians/patients should balance the potential improvement in response and disease control with a possible increase in toxicity. Initial dosing should be individualized based on patient age, renal function, comorbidities, functional status and frailty status. Subsequent dosing may be tailored based on initial response and tolerability. (Moderate Recommendation; EB-I-B) ➤ Continuous therapy should be offered over fixed duration therapy when initiating an immunomodulatory drug or proteasome inhibitor- based regimen. (Strong Recommendation; EB-H-B) ➤ The goal of initial therapy for transplant ineligible patients should be achievement of the best quality and depth of remission. (Moderate Recommendation; EB-I-B) ➤ Depth of response for all patients should be assessed by IMWG criteria (Table 5) regardless of transplant eligibility. (Moderate Recommendation; EB-H-B) ➤ There is insufficient evidence to support change in type and length of therapy based on depth of response as measured by conventional IMWG approaches or MRD. (Moderate Recommendation; IC-L-H) ➤ Upon initiation of therapy, one should define patient specific goals of therapy. Quality of life assessment (including symptom management and tolerability of treatment) should be assessed at each visit to determine if the goals of therapy are being maintained/met and this should influence the intensity and duration of treatment. Redefining the goals prospectively, based on response, symptoms and quality of life is recommended. (Moderate Recommendation; IC-L-B) ➤ It is recommended that patients be monitored closely with consideration of dose modifications based on levels of toxicity, neutropenia, fever/infection, tolerability of side effects, performance status, liver and kidney function and in keeping with the goals of treatment. (Moderate Recommendation; IC-L-B)

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