Updated 2016 NCCN Guidelines in Oncology for Multiple Myeloma Highlight Significant Changes in Clinical Practice

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Several new regimen options for the treatment of as well as the recently FDA-approved combination drug regimens are among the changes made.
Several new regimen options for the treatment of as well as the recently FDA-approved combination drug regimens are among the changes made.

The National Comprehensive Cancer Network (NCCN) 2016 version of the Clinical Practice Guidelines in Oncology for Multiple Myeloma (MM) includes new diagnostic criteria and a revised International Staging System (ISS) developed by the International Myeloma Working Group.1

The guidelines also include several new regimen options for the treatment of newly diagnosed MM as well as the recently U.S. Food and Drug Administration-approved combination drug regimens for the treatment of relapsed/refractory MM.

“The revised guidelines are critical and are kept very current to assure that the appropriate population of myeloma patients are treated, to accurately assess prognosis, and to assure access to effective and well-tolerated novel therapies for patients with both newly diagnosed and relapsed myeloma,” said lead guidelines author Kenneth Anderson, MD, who is the program director of the Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics at Dana-Farber Cancer Institute in Boston, MA.

The new NCCN guidelines for MM cover the management of patients with various plasma cell dyscrasias. These include solitary plasmacytoma, smoldering myeloma, MM, systemic light chain amyloidosis, and Waldenström's macroglobulinemia. The NCCN guidelines are updated every few years. However, they are updated even more often if new, high-quality clinical data become available in the interim. All of the recommendations in the 2016 guidelines are based on evidence from clinical trials, with very few exceptions.

Dr Anderson said there are multiple changes in the NCCN guidelines that have significant implications for clinical practice.

RELATED: Elotuzumab + Bortezomib/Dexamethasone Provide Clinical Benefit to Pts With R/R Multiple Myeloma

“First, the new International Myeloma Working Group definition of patients with active myeloma is now included in the guidelines: patients with > 60% bone marrow plasmacytosis, > 100-fold free light chain ratio, or > 1 bone lesion on positron emission tomography/computed tomography (PET/CT) of magnetic resonance imaging scanning are eligible for treatment, even in the absence of hypercalcemia, renal dysfunction, anemia, and bone disease,” Dr Anderson told Cancer Therapy Advisor.

“Second, the Refined International Staging System is now included, which adds serum lactate dehydrogenase and high-risk chromosomal abnormalities defined by FISH to the serum albumen and beta 2 micro globulin.”

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