New Multiple Myeloma Treatment Guidelines Personalize Therapy

Volume 2, Issue 2, 2013

Summary

Mayo Clinic creates practical, easy-to-follow recommendations for providing initial therapy, stem cell transplant and maintenance therapy.

Joseph R. Mikhael, M.D., a hematologist at Mayo Clinic Cancer Center in Arizona

Joseph R. Mikhael, M.D.

Researchers at the Mayo Clinic Cancer Center have developed new guidelines to treat recently diagnosed multiple myeloma patients who are not participating in clinical trials.

The guidelines give physicians practical, easy-to-follow recommendations for providing initial therapy, stem cell transplant and maintenance therapy. The guidelines were published in the April 2013 issue of the journal Mayo Clinic Proceedings and represent a consensus opinion of hematologists at Mayo Clinic Cancer Center sites in Arizona, Florida and Minnesota.

"Multiple myeloma is an incurable blood cancer that affects more than 20,000 people in the U.S. each year," said Joseph R. Mikhael, M.D., a hematologist at Mayo Clinic Cancer Center in Arizona and lead author of the guidelines article. "Over the past decade we have made great progress in understanding the disease, developing drug therapies and increasing overall survival. However, as a medical community we haven't done as good a job at optimizing therapy based on a patient's individual risk factors."

The new guidelines help patients with low-risk disease avoid the harsh side effects of therapy and reserve more intense therapy for patients with aggressive disease.

Among the guidelines:

  • A strong recommendation to enroll patients in clinical trials as the first option for therapy or supportive care.
  • Separating patients by risk into three groups to make the most of new drug therapy: high risk, intermediate risk and low risk. Previous guidelines included only two groups: high risk and standard risk.
  • Adding factors to assess the risk that multiple myeloma poses to the patient, including use of gene-expression profiling to help identify patients with high-risk disease.
  • Greater emphasis on delaying stem cell transplants to take advantage of improved chemotherapy, resulting in better responses.
  • Maintenance therapy using drugs such as lenalidomide and bortezomib that balance benefit with short- and long-term toxicity.

Watch a video of Dr. Mikhael discussing this study.