7
➤ Assessment of other risk factors such as renal insufficiency,
age, presence of plasma cell leukemia, circulating plasma cells,
extramedullary disease and frailty, should also be considered/
performed. (Strong Recommendation; EB-H-B)
➤ In patients with genetic high-risk disease a triplet combination
of proteasome inhibitor, immunomodulatory drug and a steroid
should be the initial treatment, followed by one or two autologous
SCT, followed by a proteasome inhibitor-based maintenance until
progression. (Strong Recommendation; EB-H-B)
➤ In patients with renal insufficiency, drugs should be modified based
on renal clearance. (Strong Recommendation; EB-H-B)
➤ In patients with plasma cell leukemia or extra medullary disease,
cytotoxic chemotherapy may have a role. (Moderate Recommendation;
EB-I-B)
➤ The IMWG revised response criteria should be used for response
assessment. (Strong Recommendation; EB-H-B)
➤ All measurable parameters need to be followed including light and
heavy chain analysis. (Strong Recommendation; EB-H-B)
➤ All responses excluding marrow and imaging should be confirmed as
per IMWG criteria. (Strong Recommendation; EB-H-B)
➤ Response assessment should be performed after one cycle of
therapy, and once a response trend is observed it may be done every
other cycle and less frequently once patient is in a plateau. (Strong
Recommendation; EB-H-B)
