Treatment of Multiple Myeloma: ASCO–Ontario Health (Cancer Care Ontario) Living Guideline

Guideline Objective

To provide updated guidance regarding the therapy for multiple myeloma.

Patient Population

Patients with multiple myeloma,including smouldering myeloma.

Intended Guideline Users

Clinicians and institutions providing care for patients with multiple myeloma.

Research Questions

This clinical practice guideline update addresses four topic areas with these questions:

• Should smoldering myeloma (asymptomatic) be treated?
• If smoldering myeloma is treated based on what criteria, and with what regimen(s)?
• For whom should autologous stem cell transplantation (ASCT) be offered and based on what criteria?
• What is the recommended initial therapy before ASCT?
• What post-ASCT therapy (consolidation and/or mainte- nance) is recommended and for what duration? Transplant-Ineligible Multiple Myeloma?
• What is the recommended regimen for initial therapy(ies) in transplant-ineligible patients?
• What are the outcome goals following initial therapy for transplant-ineligible patients?
• What are the recommended therapy(ies) at first relapse?
• What are the recommended therapy(ies) after subsequent relapses?
• How does previous treatment impact choice of therapy? What factors influence the choice of relapse therapy?

Note that the questions have been reorganized and reworded from the 2019 guideline and that smoldering myeloma has been added as a topic area.