Recently, the National Comprehensive Cancer Network (NCCN) announced several updates and changes to its guidelines for the diagnosis and treatment of multiple myeloma.

The NCCN guidelines are followed closely by physicians and by many U.S. health insurance companies, which frequently use them when making reimbursement decisions about different cancer treatments.

The guidelines are comprised of recommendations based on the results of recent clinical trials and ongoing scientific research.  A panel of specialists within the myeloma field is responsible for updating the NCCN guidelines for multiple myeloma.

Several changes have been made for the diagnosis, treatment, and follow-up of patients with multiple myeloma since the last updates were made in March of this year (see related Beacon news). 

The NCCN now recommends that at the time of diagnosis, patients be tested for del17p13, a deletion of a region of chromosome 17 that has been associated with poor prognosis (see related Beacon news). 

The recommendation for patients with smoldering myeloma was also changed.  Smoldering myeloma patients are now recommended to either enroll in a clinical trial or be observed for signs of progression every three to six months.  The NCCN previously only recommended that smoldering patients be observed.

For those with active myeloma, new treatment options have also been added. The combination of melphalan (Alkeran), prednisone, and Revlimid (lenalidomide) was added to the list of appropriate primary therapies for patients who are not candidates for stem cell transplantation.  Additionally, single-agent Velcade (bortezomib) was added as a maintenance therapy option. 

The panel also made the following changes to the list of salvage therapies, which are therapies given when standard therapies fail: the combination therapy of Velcade, dexamethasone, and thalidomide plus cisplatin, doxorubicin (Adriamycin), cyclophosphamide, and etoposide (VDT-PACE) was added to the list of salvage therapies. In contrast, single-agent dexamethasone as well as the combination therapy consisting of cyclophosphamide (Cytotoxan), vincristine (Oncovin), melphalan, and dexamethasone  were removed from the list.  The NCCN panelists also recommended that single-agent therapy with Revlimid or thalidomide only be considered as salvage therapy for patients who cannot tolerate steroid-based therapy.

The NCCN also updated its recommendations concerning the treatment of bone disease associated with multiple myeloma.  The NCCN now recommends that all myeloma patients receiving primary therapy be given bisphosphonate treatment to help prevent bone damage.  The NCCN previously recommended that only patients with documented bone disease receive bisphosphonate treatment.

Bisphosphonates were also added to the list of treatment options for those patients with too much calcium in the blood, with Zometa (zoledronic acid) being the preferred option for these individuals. 

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