Updates to the NCCN's Guidelines for Waldenstrom's and Myeloma

Updates have been made to the National Comprehensive Cancer Network's (NCCN) Clinical Practice Guidelines in Oncology..

These updates were presented at the recent NCCN Annual Conference. The most important updates are outlined below for both Waldenstrom's Macroglobulinemia and Multiple Myeloma by Kenneth C. Anderson MD of Dana-Farber/Brigham and Women's Cancer Center by way of OncLive.

Waldenstrom's Macroglobulinemia

According to Dr. Anderson, these updates "incorporate major progress in our ability to identify a common mutation that helps determine proper treatment."

Imbruvica (ibrutinib) is now listed as a non-stem cell toxic salvage therapy option.

Specific bone marrow testing is now considered useful in the work-up for certain patients.

Therapeutic intent ought to be "based on palliation of symptoms and not necessarily levels of IgM, unless the patient is exhibiting evidence of symptomatic hyperviscosity."

Multiple Myeloma

Dr. Anderson writes that "none of the multiple myeloma updates will radically change clinical practice, but [there are] major changes to come."

The classical definition of smoldering myeloma using tests like plain x-rays is quickly growing outdated. New efforts are now modifying these criteria to reclassify patients from "asymptomatic" to "having active disease."

Also regarding smoldering myeloma, recent studies indicate that patients with "certain characteristics including IgG levels >3 g/dL, IgA>2 g/dL, urinary Bence Jones protein > 1 g/24 hours, or abnormal free light chain ratios, have an increased risk of progression to active myeloma."

Category 2B recommendations:

  • Bortezomib (Velcade) plus prednisone cited as an option for maintenance therapy
  • Bortezomib (Velcade) plus thalidomide (Thalomid) also cited as an option for maintenance therapy
  • A two-to-three year minimum length of remission before a second autologous stem cell transplant for salvage therapy

Source: OncLive

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