OBJECTIVES: Perceiving the need for rigorous recommendations to facilitate decisions concerning the management of patients with multiple myeloma (MM), the Italian Society of Hematology (SIE) and the two affiliate societies (SIES and GITMO) commissioned a project to develop guidelines for the therapy of MM using evidence-based knowledge and consensus formation techniques. METHODS: After a comprehensive systematic review of 1,450 papers, an Expert Panel formulated and graded sixty recommendations according to the supporting evidence. Evidence gaps were filled with twenty-two consensus-based statements. High grade recommendations (grade A) are reported below. RESULTS: Treatment should be immediately initiated in MM patients with related organ damage: those patients aged below 65 years who do not have severe co-morbidities should receive autologous stem cell transplantation, while patients not candidates for autologous stem cell transplantation should receive oral melphalan and prednisone. Interferon-a should not be associated with conventional chemotherapy, but it can be offered with or without steroids as a maintenance therapy to patients who have reached a plateau phase. High-dose dexamethasone-containing regimens or high-dose dexamethasone alone are recommended as a first-line therapy when cytoreduction is urgently required (i.e., MM with spinal cord compression or with rapidly progressive renal failure). MM patients with moderate-to-severe anemia should receive erythropoietin, while patients with bone disease or osteopenia should receive long-term bisphophonates. Recommendations for the management of the clinical manifestations caused by the monoclonal protein (i.e. hyperviscosity, cast nephropathy, AL amyloidosis) and of solitary bone and extramedullary plasmacytoma were also elaborated. CONCLUSIONS: A substantial proportion of clinical care for MM can be guided by evidence-based treatment recommendations.
OBJECTIVES: Perceiving the need for rigorous recommendations to facilitate decisions concerning the management of patients with multiple myeloma (MM), the Italian Society of Hematology (SIE) and the two affiliate societies (SIES and GITMO) commissioned a project to develop guidelines for the therapy of MM using evidence-based knowledge and consensus formation techniques. METHODS: After a comprehensive systematic review of 1,450 papers, an Expert Panel formulated and graded sixty recommendations according to the supporting evidence. Evidence gaps were filled with twenty-two consensus-based statements. High grade recommendations (grade A) are reported below. RESULTS: Treatment should be immediately initiated in MM patients with related organ damage: those patients aged below 65 years who do not have severe co-morbidities should receive autologous stem cell transplantation, while patients not candidates for autologous stem cell transplantation should receive oral melphalan and prednisone. Interferon-a should not be associated with conventional chemotherapy, but it can be offered with or without steroids as a maintenance therapy to patients who have reached a plateau phase. High-dose dexamethasone-containing regimens or high-dose dexamethasone alone are recommended as a first-line therapy when cytoreduction is urgently required (i.e., MM with spinal cord compression or with rapidly progressive renal failure). MM patients with moderate-to-severe anemia should receive erythropoietin, while patients with bone disease or osteopenia should receive long-term bisphophonates. Recommendations for the management of the clinical manifestations caused by the monoclonal protein (i.e. hyperviscosity, cast nephropathy, AL amyloidosis) and of solitary bone and extramedullary plasmacytoma were also elaborated. CONCLUSIONS: A substantial proportion of clinical care for MM can be guided by evidence-based treatment recommendations.
Authors: David J McBride; Arto K Orpana; Christos Sotiriou; Heikki Joensuu; Philip J Stephens; Laura J Mudie; Eija Hämäläinen; Lucy A Stebbings; Leif C Andersson; Adrienne M Flanagan; Virginie Durbecq; Michail Ignatiadis; Olli Kallioniemi; Caroline A Heckman; Kari Alitalo; Henrik Edgren; P Andrew Futreal; Michael R Stratton; Peter J Campbell Journal: Genes Chromosomes Cancer Date: 2010-11 Impact factor: 5.006
Authors: Michele Cavo; S Vincent Rajkumar; Antonio Palumbo; Philippe Moreau; Robert Orlowski; Joan Bladé; Orhan Sezer; Heinz Ludwig; Meletios A Dimopoulos; Michel Attal; Pieter Sonneveld; Mario Boccadoro; Kenneth C Anderson; Paul G Richardson; William Bensinger; Hans E Johnsen; Nicolaus Kroeger; Gösta Gahrton; P Leif Bergsagel; David H Vesole; Hermann Einsele; Sundar Jagannath; Ruben Niesvizky; Brian G M Durie; Jesus San Miguel; Sagar Lonial Journal: Blood Date: 2011-03-29 Impact factor: 22.113
Authors: Sumana Kundu; Surajkumar B Jha; Ana P Rivera; Gabriela V Flores Monar; Hamza Islam; Sri Madhurima Puttagunta; Rabia Islam; Ibrahim Sange Journal: Cureus Date: 2022-02-25
Authors: P Tosi; M Imola; A M Mianulli; S Tomassetti; A Merli; A Molinari; S Mangianti; M Ratta; A Isidori; G Visani Journal: Mediterr J Hematol Infect Dis Date: 2012-11-05 Impact factor: 2.576