I came across the attached PDF document – the "MD Anderson Clinical Practice Algorithm for Multiple Myeloma" – this morning, and thought others here in the forum might find it both interesting and useful.
In some ways, the "algorithm" is the MD Anderson equivalent of the Mayo Clinic's "mSmart" treatment guidelines, which are referenced frequently here in the forum.
The MD Anderson document doesn't have the risk-based classification and treatment approach that the Mayo guidlines do. It is also a bit out of date because it was published early last year, prior to the approvals of Ninlaro (ixazomib), Empliciti (elotuzumab), and Darzalex (daratumumab).
Nevertheless, it's interesting to see what MD Anderson recommends, and I think the recommendations related to adjunctive therapies and lab work could be particularly useful for questions that come up frequently here in the forum.
(Please note that I have no affiliation or connection of any kind with MD Anderson.)
Forums
5 posts
• Page 1 of 1
MD Anderson Treatment Algorithm (April 2015)
- Attachments
-
MDAndersonMMTx201504.pdf- (532.17 KiB) Downloaded 1014 times
Re: MD Anderson Treatment Algorithm (April 2015)
Excellent! Thank you for posting.
-
jrj001 - Name: Jim
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 3/15
- Age at diagnosis: 61
Re: MD Anderson Treatment Algorithm (April 2015)
Hi TerryH,
Thanks a lot for posting this. Very interesting. At my next visit, I want to ask my myeloma specialist at Memorial Sloan Kettering (MSK) if they use something similar to this.
In addition to your observations, there were a couple of things that caught my eye. In Note 2 on Page 1, they include t(4:14) and any chromosome 1 abnormalities with other high risk cytogenetics. And they recommend considering mini-all transplants for those cases. mSMART and I think some other things I've seen consider those as intermediate risk.
Also, if I'm reading things right on Page 5, it looks like they do not recommend CyBorD (cyclophosphamide, Velcade, and dexamethasone) as an induction treatment. That seems a little surprising to me because I thought it was still fairly often used for induction.
They also say "The best role for maintenance therapy has not been determined." (Note 4, Page 2). So it is included as an option for almost all cases after induction and/or stem cell transplant. Probably the best way to handle maintenance at this point in time. However, I get the impression that MSK is more aggressive in recommending it.
Those are the individual "trees" in my observations. Then it hit me that there is a "forest" to consider as well. This flow chart, all the notes, and all the options are pretty darn complicated! That, and the differences between these guidelines and mSMART (and "best practices" at other myeloma centers) reflect the nature of multiple myeloma - it's a complicated disease. Unfortunately.
Mike
Thanks a lot for posting this. Very interesting. At my next visit, I want to ask my myeloma specialist at Memorial Sloan Kettering (MSK) if they use something similar to this.
In addition to your observations, there were a couple of things that caught my eye. In Note 2 on Page 1, they include t(4:14) and any chromosome 1 abnormalities with other high risk cytogenetics. And they recommend considering mini-all transplants for those cases. mSMART and I think some other things I've seen consider those as intermediate risk.
Also, if I'm reading things right on Page 5, it looks like they do not recommend CyBorD (cyclophosphamide, Velcade, and dexamethasone) as an induction treatment. That seems a little surprising to me because I thought it was still fairly often used for induction.
They also say "The best role for maintenance therapy has not been determined." (Note 4, Page 2). So it is included as an option for almost all cases after induction and/or stem cell transplant. Probably the best way to handle maintenance at this point in time. However, I get the impression that MSK is more aggressive in recommending it.
Those are the individual "trees" in my observations. Then it hit me that there is a "forest" to consider as well. This flow chart, all the notes, and all the options are pretty darn complicated! That, and the differences between these guidelines and mSMART (and "best practices" at other myeloma centers) reflect the nature of multiple myeloma - it's a complicated disease. Unfortunately.
Mike
-
mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: MD Anderson Treatment Algorithm (April 2015)
Hi everyone,
I was doing some poking around on the Internet this morning and I noticed that MD Anderson has updated its treatment guidelines for multiple myeloma. I'm posting the updated document, which is from September 2018, as an attachment to this post.
As with most treatment guidelines, the document gives doctors a lot of choices at each stage of the disease. There are at least four or five options listed as initial treatment for newly diagnosed patients, for example.
I was doing some poking around on the Internet this morning and I noticed that MD Anderson has updated its treatment guidelines for multiple myeloma. I'm posting the updated document, which is from September 2018, as an attachment to this post.
As with most treatment guidelines, the document gives doctors a lot of choices at each stage of the disease. There are at least four or five options listed as initial treatment for newly diagnosed patients, for example.
- Attachments
-
- MDAndersonMMTxs201809.pdf
- (1.16 MiB) Downloaded 212 times
Re: MD Anderson Treatment Algorithm (April 2015)
Thanks Terry!
-
Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
5 posts
• Page 1 of 1
Return to Treatments & Side Effects