What are the guidelines on the European Myeloma Network management of multiple myeloma (MM) complications?

Updated: Jul 15, 2019
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Guidelines on the management of multiple myeloma complications by the European Myeloma Network include the following recommendations [121] :

  • Whole body low-dose computed tomography is more sensitive than conventional radiography in depicting osteolytic disease and thus is recommended as the novel standard for the detection of lytic lesions in myeloma.
  • Myeloma patients with adequate renal function and bone disease at diagnosis should be treated with zoledronic acid or pamidronate.
  • Symptomatic patients without lytic lesions on conventional radiography can be treated with zoledronic acid, but its advantage is not clear for patien ts with no bone involvement on computed tomography or magnetic resonance imaging.
  • In asymptomatic myeloma, bisphosphonates are not recommended.
  • Zoledronic acid should be given continuously, but it is not clear if patients who achieve at least a very good partial response benefit from its continuous use.
  • Treatment with erythropoietic-stimulating agents may be initiated in patients with persistent symptomatic anemia (hemoglobin < 10g/dL) in whom other causes of anemia have been excluded.
  • Erythropoietic agents should be stopped after 6-8 wk if no adequate hemoglobin response is achieved.
  • For renal impairment, bortezomib-based regimens are the current standard of care.
  • For the management of treatment-induced peripheral neuropathy, drug modification is needed.
  • Vaccination against influenza is recommended; vaccination against Streptococcus pneumoniae and Haemophilus influenzae is appropriate, but efficacy is not guaranteed due to suboptimal immune response.
  • Prophylactic acyclovir (or valacyclovir) is recommended for patients receiving proteasome inhibitors, or autologous or allogeneic transplantation

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