What are the European Myeloma Network treatment guidelines for multiple myeloma (MM) complications?

Updated: May 11, 2021
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Guidelines on the management of multiple myeloma complications by the European Myeloma Network include the following recommendations [128] :

  • 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 ESAs 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.

A guideline from the European Myeloma Network includes the following recommendations for vaccination in multiple myeloma [137] :

  • Influenza - All patients, nonimmune family members, close contacts and healthcare workers
  • Hepatitis A -  Patients traveling to areas of high endemicity
  • Hepatitis B - Patients traveling to areas of high endemicity, behavioral/occupational exposure, hemodialysis
  • Pneumococci -  PCV13, all patients; PPV23, > 2 months, or 6–12 months, after PCV13
  • Haemophilus influenzae – All patients
  • Meningococci - Patients with asplenia, complement deficiency, recurrent episodes of bacterial infections
  • Diptheria/tetanus/acellular pertussis (DTaP) - Patients who did not receive a primary vaccination for DTaP, or a booster dose of tetanus and diphtheria toxoid vaccine. May be limited to tetanus only, based on epidemiological prevalence
  • Herpes zoster – All patients

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