The National Comprehensive Cancer Network (NCCN) recently announced several additions and changes to its guidelines for the diagnosis and treatment of multiple myeloma at the NCCN 16^th Annual Conference on March 11.

The NCCN guidelines are used by physicians when deciding among treatment options for their patients and also by Medicare to determine whether to pay for treatments if the drugs are used differently than their FDA-approved use.

Several treatment options for multiple myeloma were added to the latest edition of the NCCN guidelines.

For transplant candidates, the NCCN added the combination of Velcade (bortezomib), cyclophosphamide (Cytoxan), and dexamethasone (Decadron) as an option for induction therapy.  For non-transplant candidates, two induction therapies were added: Velcade plus dexamethasone as well as melphalan (Alkeran), prednisone, and Revlimid (lenalidomide) combination therapy.

For patients who have relapsed after previous therapy, two combinations have been added as options for salvage therapy.  Both are combinations of cyclophosphamide and dexamethasone with either Velcade or Revlimid.

The NCCN also changed a few recommendations regarding initial diagnostic workup.

The NCCN added serum free light chain (FLC) assay to its recommendations for initial patient diagnostic workup. The serum FLC assay, which had previously been considered “useful under some circumstances,” may be used to track disease progression and response to treatment.

In addition, the NCCN recommended that physicians perform fluorescence in situ hybridization (FISH) for 1q21 amplification (a duplication of a region of chromosome 1) in the initial diagnostic workup. FISH, a technique that identifies chromosomal abnormalities, can determine whether a patient has the 1q21 amplification, which has been associated with poor prognosis.

The NCCN also expanded the primary treatment options for multiple myeloma patients who also have systemic light chain amyloidosis, a condition in which proteins aggregate in the organs or tissues. The updated treatment options for these patients now include Velcade plus dexamethasone or cyclophosphamide, thalidomide (Thalomid), and dexamethasone.

For more information, see the NCCN guidelines for multiple myeloma (free registration required).