DOI: 10.1097/01.COT.0000295383.33799.01

,  

Issn Print: 0276-2234

Publication Date: 2006/05/10


Print

NCCN Tweaks Guidelines for Myeloma; Suggest Watching Smoldering Form

Ed Susman

    loading  Checking for direct PDF access through Ovid

Excerpt

HOLLYWOOD, FL—Sometimes diagnosing a disease correctly may lead to a treatment in which the observation becomes the treatment of choice. That's the case for patients with Stage 1 multiple myeloma, at least according to new guidelines from the National Comprehensive Cancer Network (NCCN), the 19-insitution consortium that has been writing treatment algorithm since 1996.
“Primary treatment of systemic, smoldering, or Stage 1 myeloma is observation,” said Seema Singhal, MD, Professor of Medicine and Director of the Multiple Myeloma Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, speaking here at the NCCN's 11th Annual Conference. “The panel expanded this recommendation to include the time interval of three to six months.”
The guidelines indicate that people identified with the smoldering type of multiple myeloma may have disease without symptoms for many years. “These patients have low concentrations of M-protein—the marker of disease progression—and bone marrow infiltration with 10% to 20% of plasma cells; however, they do not have anemia, renal failure, hypercalcemia, or bone lesions,” Dr. Singhal said.
Patients diagnosed with Durie-Salmon Stage 1 myeloma also have low M-protein without much anemia, hypercalcemia, or bone disease, and that is included as part of the group of smoldering or indolent myeloma.
“Patients with smoldering or Stage 1 myeloma do not need primary therapy, because they can do well for many months to years before the disease progresses,” the new guidelines state.
The algorithm suggests that doctors see patients diagnosed with Stage 1 myeloma every three to six months. Those with more aggressive disease are seen every month or more often. Stage 1 patients unfortunately typically have disease progression, after which the guidelines for Stage 2 and more aggressive myelomas should be followed.
    loading  Loading Related Articles