3
➤ Ample stem cell collection (sufficient for more than one SCT) should
be considered upfront, due to concern for limited ability for future
stem cell collection after prolonged treatment exposure. (Moderate
Recommendation; EB-I-B)
➤ The level of minimal response required to proceed to SCT is not
established for patients receiving induction therapy – patients should
be referred for SCT independent of depth of response. (Moderate
Recommendation; EB-I-B)
➤ High-dose melphalan is the recommended conditioning regimen for
Auto SCT. (Strong Recommendation; EB-H-B)
➤ Tandem autologous SCT should not be routinely recommended.
(Strong Recommendation; EB-I-B/H)
➤ Salvage or delayed SCT may be used as consolidation at first relapse
for those not choosing to proceed to transplant initially. (Moderate
Recommendation; EB-I-B)
➤ Allogeneic transplant for multiple myeloma is not routinely
recommended but may be considered in select high risk patients or in
the context of a clinical trial. (Strong Recommendation; EB-I-B)
➤ Consolidation therapy is not routinely recommended but may be
considered in the context of a clinical trial. For patient's ineligible or
unwilling to consider maintenance therapy, consolidation therapy for
at least 2 cycles may be considered. (Moderate Recommendation;
EB-I-B)
➤ Lenalidomide maintenance therapy should be routinely offered to
standard risk patients starting at approximately day 90-110 at 10-15
mg daily until progression. A minimum of 2 years of maintenance
therapy is associated with improved survival, and efforts to maintain
therapy for at least this duration are recommended. (Strong
Recommendation; EB-H-B)
➤ For patients intolerant of or unable to receive lenalidomide,
bortezomib maintenance every 2 weeks may be considered.
(Moderate Recommendation; IC/EB-L/I-B)
➤ For high-risk patients, maintenance therapy with a proteasome
inhibitor +/- lenalidomide may be considered. (Moderate
Recommendation; IC/EB-L/I-B)
➤ There is insufficient evidence to make modifications to maintenance
therapy based on depth of response, including minimal residual
disease (MRD) status. (Moderate Recommendation; IC/EB-L/I-B)
Treatment
