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Multiple Myeloma (MM) is the second most common malignant tumor of the hematological system, accounting for about 10% of hematological malignancies.
In recent years, the level of diagnosis and treatment of MM in my country has made great progress, gradually in line with the international level, and the continuous emergence of new drugs has made rapid progress in the field of MM.
At the 2021 Chinese Society of Clinical Oncology (CSCO) Guidelines Conference held on April 23-24, Professor Gong Tiejun from the Harbin Institute of Hematology and Oncology gave a detailed and wonderful update on the "2021 CSCO Guidelines for Diagnosis and Treatment of Hematological Malignancies" explain.
What are the updates in the multiple myeloma part? Let us look at it together.
Pre-treatment assessment and staging update points The evidence level of "Hevylite" in laboratory examinations was adjusted from level I recommendation to level II recommendation; "Urine fixed electrophoresis (level I recommendation)" was added; "M protein quantification" (Level II recommendation)"; "Hepatitis B markers and DNA (Level II recommendation)".
"Diffuse nuclear magnetic field (DWI-XRI) (Level III recommendation)" has been added to the skeletal examination; "Whole body low-dose CT can be used for the examination of whole-body bone lesions" was recommended by level III experts and adjusted to level II recommendation.
In the cytogenetic blood test, "MRD for the second-generation sequencing detection of VDI rearrangement in the IgHV area (level II recommendation)" has been added.
In the remarks of the R-ISS standard, “solitary plasmacytoma is greater than 5 cm in diameter; multiple plasmacytomas should be treated as multiple myeloma (category 2A)”.
Update key points of treatment options suitable for transplantation of newly diagnosed multiple myeloma: In the induction therapy, "Isazomib + lenalidomide + dexamethasone (2B evidence), lenalidomide + cyclophosphamide + dexamethasone (2A) Class Evidence)” was adjusted from the recommendation of level III experts to the recommendation of level II experts, with the addition of “daretuzumab + bortezomib + lenalidomide + dexamethasone (category 2) and daretuzumab + "Bortezomib + Thalidomide + Dexamethasone (Class 2)" is a level II recommendation.
Consolidation therapy added "combination chemotherapy similar to induction therapy (2A) as a level II recommendation.
Maintenance therapy added "Isazomib (category 1) as a level I recommendation, lenalidomide + bortezomib ( Class 2A) and Lenalidomide + Ishazomib (Class 2A) are recommended for Class II.
"Sequential autologous-allogeneic hematopoietic stem cell transplantation, young and high-risk patients (category 2B) and allogeneic hematopoietic stem cell transplantation, young and high-risk patients (category 2B)" are added to the transplantation as recommended by level III experts.
In stem cell mobilization, cyclophosphamide+G-CSF (category 1A) has been added as level I recommendation, and G-CSF+Plexafor (category 1B), G-CSF (category 2A) and E-CHOP (category 2) as level II Grade III recommendation and cyclophosphamide+G-CSF+Plexifo are recommended as Grade III.
Not suitable for transplantation of newly diagnosed multiple myeloma: "Bortezomib + Melphalan + Dexamethasone (Class 1), Thalidomide + Melphalan + Dexamethasone (Class 1)" has been added to the induction therapy as recommended by level I experts .
In the maintenance treatment, "Isazomib (Class 1) was added as a level I recommendation, and lenalidomide + bortezomib (category 2A) and lenalidomide + ixazomib (category 2A) were recommended as a level II recommendation.
In the "2020 CSCO Guidelines for the Diagnosis and Treatment of Hematological Malignancies", there is no clear recommendation for the treatment of patients with relapsed and refractory diseases.
This update adds a clear treatment plan.
The updated points of supportive treatment are added in patients with bone diseases.
"Disulumab (Level I recommendation)"; "Surgical intervention" was reduced from Level I recommendation to Level II recommendation; "Radiotherapy (Level III recommendation)" was added.
For patients with renal insufficiency, "High cut-off" was added Volume dialysis (level II recommendation)".
Added "G-CSF (Prevention of Granulocytopenia)" in the infection section as a level II recommendation.
In the anemia section, add "Before using daratumumab, patients should be tested for blood group identification and antibody screening (level II recommendation).
"Stick" to read the original text, and we will make progress together
In recent years, the level of diagnosis and treatment of MM in my country has made great progress, gradually in line with the international level, and the continuous emergence of new drugs has made rapid progress in the field of MM.
At the 2021 Chinese Society of Clinical Oncology (CSCO) Guidelines Conference held on April 23-24, Professor Gong Tiejun from the Harbin Institute of Hematology and Oncology gave a detailed and wonderful update on the "2021 CSCO Guidelines for Diagnosis and Treatment of Hematological Malignancies" explain.
What are the updates in the multiple myeloma part? Let us look at it together.
Pre-treatment assessment and staging update points The evidence level of "Hevylite" in laboratory examinations was adjusted from level I recommendation to level II recommendation; "Urine fixed electrophoresis (level I recommendation)" was added; "M protein quantification" (Level II recommendation)"; "Hepatitis B markers and DNA (Level II recommendation)".
"Diffuse nuclear magnetic field (DWI-XRI) (Level III recommendation)" has been added to the skeletal examination; "Whole body low-dose CT can be used for the examination of whole-body bone lesions" was recommended by level III experts and adjusted to level II recommendation.
In the cytogenetic blood test, "MRD for the second-generation sequencing detection of VDI rearrangement in the IgHV area (level II recommendation)" has been added.
In the remarks of the R-ISS standard, “solitary plasmacytoma is greater than 5 cm in diameter; multiple plasmacytomas should be treated as multiple myeloma (category 2A)”.
Update key points of treatment options suitable for transplantation of newly diagnosed multiple myeloma: In the induction therapy, "Isazomib + lenalidomide + dexamethasone (2B evidence), lenalidomide + cyclophosphamide + dexamethasone (2A) Class Evidence)” was adjusted from the recommendation of level III experts to the recommendation of level II experts, with the addition of “daretuzumab + bortezomib + lenalidomide + dexamethasone (category 2) and daretuzumab + "Bortezomib + Thalidomide + Dexamethasone (Class 2)" is a level II recommendation.
Consolidation therapy added "combination chemotherapy similar to induction therapy (2A) as a level II recommendation.
Maintenance therapy added "Isazomib (category 1) as a level I recommendation, lenalidomide + bortezomib ( Class 2A) and Lenalidomide + Ishazomib (Class 2A) are recommended for Class II.
"Sequential autologous-allogeneic hematopoietic stem cell transplantation, young and high-risk patients (category 2B) and allogeneic hematopoietic stem cell transplantation, young and high-risk patients (category 2B)" are added to the transplantation as recommended by level III experts.
In stem cell mobilization, cyclophosphamide+G-CSF (category 1A) has been added as level I recommendation, and G-CSF+Plexafor (category 1B), G-CSF (category 2A) and E-CHOP (category 2) as level II Grade III recommendation and cyclophosphamide+G-CSF+Plexifo are recommended as Grade III.
Not suitable for transplantation of newly diagnosed multiple myeloma: "Bortezomib + Melphalan + Dexamethasone (Class 1), Thalidomide + Melphalan + Dexamethasone (Class 1)" has been added to the induction therapy as recommended by level I experts .
In the maintenance treatment, "Isazomib (Class 1) was added as a level I recommendation, and lenalidomide + bortezomib (category 2A) and lenalidomide + ixazomib (category 2A) were recommended as a level II recommendation.
In the "2020 CSCO Guidelines for the Diagnosis and Treatment of Hematological Malignancies", there is no clear recommendation for the treatment of patients with relapsed and refractory diseases.
This update adds a clear treatment plan.
The updated points of supportive treatment are added in patients with bone diseases.
"Disulumab (Level I recommendation)"; "Surgical intervention" was reduced from Level I recommendation to Level II recommendation; "Radiotherapy (Level III recommendation)" was added.
For patients with renal insufficiency, "High cut-off" was added Volume dialysis (level II recommendation)".
Added "G-CSF (Prevention of Granulocytopenia)" in the infection section as a level II recommendation.
In the anemia section, add "Before using daratumumab, patients should be tested for blood group identification and antibody screening (level II recommendation).
"Stick" to read the original text, and we will make progress together
