Researchers at 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 are published in the current issue of the journal Mayo Clinic Proceedings and represent a consensus opinion of hematologists at Mayo Clinic Cancer Center sites in Minnesota, Florida and Arizona.
"Multiple myeloma is an incurable blood cancer that affects more than 20,000 people in the U.S. each year," says lead author Joseph Mikhael, M.D. a hematologist at Mayo Clinic in Arizona. "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."
Dr. Mikhael says the new guidelines will help patients with low-risk disease avoid the harsh side effects of therapy and will 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 the 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.
Co-authors include David Dingli, M.D., Ph.D.; Vivek Roy, M.D.; Craig Reeder, M.D.; Francis Buadi, M.D.; Suzanne Hayman, M.D.; Angela Dispenzieri, M.D.; Rafael Fonseca, M.D.; Taimur Sher, M.D.; Robert Kyle, M.D.; Yi Lin, M.D., Ph.D.; Stephen Russell, M.D., Ph.D.; Shaji Kumar, M.D.; Leif Bergsagel, M.D.; Steven Zeldenrust, M.D., Ph.D.; Nelson Leung, M.D.; Matthew Drake, M.D., Ph.D.; Prashant Kapoor, M.D.; Stephen Ansell, M.D., Ph.D.; Thomas Witzig, M.D.; John Lust, M.D., Ph.D.; Robert Dalton, M.D.; Morie Gertz, M.D.; Keith Stewart, M.B.Ch.B.; Vincent Rajkumar, M.D.; Asher Chanan-Khan, M.D.; and Martha Lacy, M.D., all of Mayo Clinic.
- Joseph R. Mikhael, David Dingli, Vivek Roy, Craig B. Reeder, Francis K. Buadi, Suzanne R. Hayman, Angela Dispenzieri, Rafael Fonseca, Taimur Sher, Robert A. Kyle, Yi Lin, Stephen J. Russell, Shaji Kumar, P. Leif Bergsagel, Steven R. Zeldenrust, Nelson Leung, Matthew T. Drake, Prashant Kapoor, Stephen M. Ansell, Thomas E. Witzig, John A. Lust, Robert J. Dalton, Morie A. Gertz, Keith Stewart, S. Vincent Rajkumar, Asher Chanan-Khan, Martha Q. Lacy. Management of Newly Diagnosed Symptomatic Multiple Myeloma: Updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Guidelines 2013. Mayo Clinic Proceedings, 2013; 88 (4): 360 DOI: 10.1016/j.mayocp.2013.01.019
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