多發(fā)性骨髓瘤2021.v5（英文）-NCCN腫瘤臨床實(shí)踐指南

NCCNClinicalPracticeGuidelinesinOncologyNCCNGuidelines?)MultipleMyelomarsionMarchNCCNGuidelinesforPatients?availableat/patientsVersion5.2022,03/09/22?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon3/14/20227:04:15AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dex*ShajiK.Kumar,MD/Chair?ξMayoClinicCancerCenter*NatalieS.Callander,MD/ViceChair?ξUniversityofWisconsineCancerCenterKehindeAdekola,MD,MSCI??RobertH.LurieComprehensiveCancerCenterofNorthwesternUniversityLarryD.Anderson,Jr.,MD,PhD??UTSouthwesternSimmonsComprehensiveCancerCenterMuhamedBaljevic,MD??TξVanderbilt-IngramCancerCenterEricaCampagnaro,MD?UniversityofMichiganRogelCancerCenterJorgeJ.Castillo,MD?Dana-Farber/BrighamandWomen’sCancerCenter|MassachusettsGeneralHospitalCancerCenterCaitlinCostello,MD??ξUCSanDiegoMooresCancerCenterChristopherD'Angelo,MD?Fred&PamelaBuffettCancerCenterSrinivasDevarakonda,MD??TheOhioStateUniversityComprehensiveCancerCenter-JamesCancerHospitalandSoloveResearchInstituteNouraElsedawy,MD?St.JudeChildren'sResearchHospital/TheUniversityofTennesseeeCenteratthewFaimanMDMBArehensiveCancerCenteriversityHospitalsSeidmanCancerCenternstituteAlfredGarfall,MD?AbramsonCancerCenterheUniversityofPennsylvaniaKellyGodby,MD?O'NealComprehensiveCancerCenteratUABJensHillengass,MD,PhD?RoswellParkComprehensiveCancerCenterLeonaHolmberg,MD,PhDξ?FredHutchinsonCancerResearchCenter/SeattleCancerCareAllianceMyoHtut,MD?TCityofHopeNationalMedicalCenterCarolAnnHuff,MD??TheSidneyKimmelComprehensiveCancerCenteratJohnsHopkinsMalinHultcrantz,MD,PhD??MemorialSloanKetteringCancerCenterYubinKang,MD??ξDukeCancerInstituteSarahLarson,MD?UCLAJonssonComprehensiveCancerCenterMichaelaLiedtke,MD?StanfordCancerInstituteThomasMartin,MD?UCSFHelenDillerFamilyComprehensiveCancerCenterJamesOmelMD￥eDouglasSborov,MD,MSc??TξHuntsmanCancerInstituteattheUniversityofUtahKennethShain,MD,PhD?MoffittCancerCenterKeithStockerl-Goldstein,MD?ξSitemanCancerCenteratBarnes-JewishHospitalandWashingtonUniversitySchoolofMedicineDonnaWeber,MD??TTheUniversityofTexasdiMScesPanelDisclosuresξBonemarrowtransplantation?Medicaloncology?Hematology￥PatientadvocacyeeTInternalmedicine*DiscussionsectioneeVersion5.2022,03/09/22?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.MyelomaPanelMembersryofGuidelinesUpdatesicWorkupandClinicalFindingsMYELSolitaryPlasmacytomaorSolitaryPlasmacytomawithMinimalMarrowInvolvement:PrimaryTreatmentandMyelomaPanelMembersryofGuidelinesUpdatesicWorkupandClinicalFindingsMYELSolitaryPlasmacytomaorSolitaryPlasmacytomawithMinimalMarrowInvolvement:PrimaryTreatmentandFollow-up/Surveillance(MYEL-2)SmolderingMyelomaAsymptomaticPrimaryTreatmentandFollowUpSurveillanceMYEL-3)MultipleMyelomaSymptomaticPrimaryTreatmentandFollowUpSurveillanceMYEL-4)MultipleMyelomaSymptomaticResponseAfterPrimaryTherapyandFollowUpSurveillanceMYEL)tmentPostAutologousHematopoieticCellTransplantMYELyelomaSymptomaticAdditionalTreatmentforRelapseorProgressiveDiseaseMYELStagingSystemsforMultipleMyeloma(MYEL-A)PrinciplesofImaging(MYEL-B)DefinitionsofSmolderingandMultipleMyeloma(MYEL-C)PrinciplesofRadiationTherapy(MYEL-D)ResponseCriteriaforMultipleMyeloma(MYEL-E)GeneralConsiderationsforMyelomaTherapy(MYEL-F)MyelomaTherapy(MYEL-G)SupportiveCareforMultipleMyeloma(MYEL-H)ManagementofVenousThromboembolism(VTE)inMultipleMyeloma(MYEL-I)ManagementofRenalDiseaseinMultipleMyeloma(MYEL-J)mmopathyofClinicalSignificance?MonoclonalGammopathyofRenalSignificance(MGRS-1)?MonoclonalGammopathyofNeurologicalSignificance(MGNS-1)POEMSPolyneuropathyOrganomegalyEndocrinopathyMonoclonalProtein,SkinChanges)(POEMS-1)dexClinicalTrials:NCCNbelievesthatthebestmanagementforanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.ernorgtutionsNCCNCategoriesofPreference:Allrecommendationsareconsideredappropriate.TheNCCNGuidelinesareastatementofevidenceandconsensusoftheauthorsregardingtheirviewsofcurrentlyacceptedapproachestotreatmentAnyclinicianseekingtoapplyorconsulttheNCCNGuidelinesisexpectedtouseindependentmedicaljudgmentinthecontextofindividualstancestodetermineanypatientscareortreatmentTheNationalComprehensiveCancerNetworkNCCNmakesnorepresentationsorwarrantiesofanykindregardingtheircontentuseorapplicationanddisclaimsanyresponsibilityfortheirapplicationoruseinanywayTheNCCNbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.?2021.Version5.2022,03/09/22?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.PrintedbyMinTangon3/14/20227:04:15AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexsionoftheNCCNGuidelinesforMultipleMyelomafromVersionincludeMYEL-G4of4?TherapyforPreviouslyTreatedMultipleMyelomapTherapiesforpatientswithLateRelapses(>3priortherapies):?Ciltacabtageneautoleucelwasaddedasanoptionafteratleastfourpriortherapies,includingananti-CD38monoclonalantibody,aPI,andanIMiD.sionoftheNCCNGuidelinesforMultipleMyelomafromVersionincludeMYEL-G3of4?TherapyforPreviouslyTreatedMultipleMyeloma:pThefollowingregimenwasremovedfromOtherRecommendedRegimensforEarlyRelapse(1-3priortherapies):?Panobinostat/bortezomib/dexamethasone(category1)MYEL-G4of4?TherapyforPreviouslyTreatedMultipleMyelomapUsefulinCertainCircumstancesforEarlyRelapses(1-3priortherapies):?Thefollowingnewregimenwasadded:Selinexor/carfilzomib/dexamethasone?Thefollowingwereremoved:–AftertwopriortherapiesincludingbortezomibandanIMiD:?Panobinostat/carfilzomibinostatlenalidomidedexamethasoneNote:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version5.2022,03/09/22?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.UPDATESPrintedbyMinTangon3/14/20227:04:15AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexUpdatesinVersion3.2022oftheNCCNGuidelinesforMultipleMyelomafromVersion2.2022include:MYEL-G4of4?TherapiesforLateRelapses(>3priortherapies)pTheregimenmelphalanflufenamide/dexamethasonewasremoved.sionoftheNCCNGuidelinesforMultipleMyelomafromVersionincludeMYEL-G1of4and2of4?MaintenanceTherapypOtherRecommendedRegimens?Ixazomibwasmodifiedto:Ixazomib(category1category2B)?Footnoteiadded:ResultsfrominterimanalysesofTOURMALINEMM3andMM4trialsofixazomibinthemaintenancesettingsuggestsapotentialdecreaseinoverallsurvival.MYEL-G2of4?PrimaryTherapyforNon-TransplantCandidatespPreferredRegimens?FootnotejremovedfromregimenBortezomib/lenalidomide/dexamethasone:Thisistheonlyregimenshowntohaveoverallsurvival.benefit.UpdatesinVersion1.2022oftheNCCNGuidelinesforMultipleMyelomafromVersion7.2021include:MYEL-2MYEL-3parameterflowcytometryasclinicallyparameterflowcytometryasclinically?Follow-UpSurveillancedicatedneededpSecondbulletadded:TestsdicatedneededThirdbulletrevisedWhole-bodyimagingwithMRIwithoutThirdbulletrevisedWhole-bodyimagingwithMRIwithoutcontrast,wdoseCTscanFDGPETCTannuallyorasclinicallyindicatedSPEP,withSIFEasneededneeded,ideallywiththesametechniqueusedatdiagnosis.MYEL-4needed,ideallywiththesametechniqueusedatdiagnosis.MYEL-4FootnotedaddedfromMYEL1:SkeletalsurveyisacceptableintaincircumstancesHoweveritissignificantlylesssensitivethanowdoseCTandFDGPETCTIfwholebodyFDGPETCTorlow-doseCThasbeenperformed,thenskeletalsurveyisnotneeded.?Fourthsub-bulletrevised:SerumLDHandbeta-2microglobulinasclinicallyindicated?Fifthsub-bulletrevised:Bonemarrowaspirateandbiopsyasclinicallyindicated?Sixthsub-bulletadded:Allplasmacytomasshouldbeimagedyearly,preferablywiththesametechniqueusedatdiagnosis,foratleast5years.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version5.2022,03/09/22?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.UPDATESPrintedbyMinTangon3/14/20227:04:15AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexsionoftheNCCNGuidelinesforMultipleMyelomafromVersioninclude?MultipleMyeloma(Symptomatic)pRevised:Tandemautologousorallogeneichematopoieticcelltransplant,undercertaincircumstances.?Follow-Up/SurveillancepThirdbulletrevised:24-hurinefortotalprotein,UPEP,andUIFEatbaselineandasclinicallyindicatedneededorifthereisasignificantchangeinFLClevelspFifthbulletrevised:Whole-bodyadvancedimagingwithFDGPET/CT,low-doseCTscan,MRIwithoutcontrastasclinicallyneeded,ideallywiththesametechniqueusedatpSixthbulletrevised:BonemarrowaspirateandbiopsywithmultiparameterflowcytometryasclinicallyindicatedneededMYEL-B1of2?ImagingforInitialDiagnosticWorkup(forpatientssuspectedofmyeloma/solitaryplasmacytoma)pFirstbulletrevisedbyaddingsentence:AsmallpercentageofpatientsmayhaveanegativePET/CTwithactiveMM.?ImagingforFollow-upofMMpFirstbulletrevised:Advancedwhole-bodyimaging(ie,FDGPET/CT,low-doseCTscan,whole-bodyMRIwithoutcontrast)isrecommendedasclinicallyindicatedneeded.MYEL-CFootnotebaddedBMPCs)>20%,M-protein>2g/dL,and(FLCr)arevariablesusedtoriskstratifypatientsatdiagnosis.PatientswithtwoormoreoftheseriskfactorsareconsideredtoighriskofprogressiontoMMLakshmanAetalBloodCancerJ2018;8:59.?SolitaryPlasmacytomapTreatmentInformation/Dosing:?Firstbullet,firstsub-bulletrevised:RT(40–50Gyin1.8–2.0Gyfractions[20–25totalfractions])toinvolvedfield.?MultipleMyelomapPalliativeRTDosingforMM?Firstbulletrevised:Low-doseRT(8Gyx1fractionor10–30Gyin2.0–3.0Gyfractions[5–10totalfractions])canbeusedaspalliativetreatmentforuncontrolledpain,forimpendingpathologicfracture,orforimpendingcordcompression.MYEL-F?Headinghasbeenrevised:PrinciplesofGeneralConsiderationsfor?GeneralPrinciplespFourthbulletadded:FortheMyelomaFrailtyScoreCalculatordevelopedbyInternationalMyelomaWorkingGroupfortheprognosisofelderlymyelomapatients,seehttp://www./pFifthbulletadded:Considerdosemodificationsbasedonfunctionalstatusandage.?DosingandAdministrationpFourthbulletwasmovedfromMYEL-G:Foranyregimenthatincludesdaratumumab,thiscouldbedaratumumabforintravenousinfusionordaratumumabandhyaluronidase-fihjforsubcutaneousinjection.Daratumumabandhyaluronidase-fihjforsubcutaneousinjectionhasdifferentdosingandadministrationinstructionscomparedtodaratumumabforintravenousinfusion.?Referenceadded:PalumboA,BringhenS,MateosMV,etal.Geriatricassessmentpredictssurvivalandtoxicitiesinelderlymyelomapatients:AnInternationalMyelomaWorkingGroupreport.Blood2015;125:2068-2074.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version5.2022,03/09/22?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.UPDATESPrintedbyMinTangon3/14/20227:04:15AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.dexsionoftheNCCNGuidelinesforMultipleMyelomafromVersionincludeMYEL-G1of4?PrimaryTherapyforTransplantCandidatespThefollowingregimensweremovedfromPreferredRegimenstoUsefulinCertainCircumstances?Bortezomib/cyclophosphamide/dexamethasonepThefollowingnewregimenwasaddedtoUsefulinCertainCircumstancesdexamethasone?MaintenanceTherapypUsefulinCertainCircumstances?TheregimenBortezomib/lenalidomidewasrevisedtoBortezomib/lenalidomide±dexamethasone?FootnotefwasmovedtoGeneralConsiderationsforMyelomaTherapy.(AlsoforMYEL-G2of4)?Footnoteiadded:Dualmaintenancerecommendedforhigh-riskMM.MYEL-G2of4?PrimaryTherapyforNon-TransplantCandidatespThefollowingregimensweremovedfromPreferredRegimenstoUsefulinCertainCircumstances:?Lenalidomide/low-dosedexamethasone(category1)?Bortezomib/cyclophosphamide/dexamethasonepThefollowingnewregimenwasaddedtoUsefulinCertainCircumstances:?Bortezomib/lenalidomide/dexamethasone(VRD-lite)forfrailPatients?MaintenanceTherapypThefollowingregimenwasaddedtoOtherRecommendedRegimens:?Ixazomib(category1)MYEL-G3of4?Regimenswerereorganizedbyearly(1-3priortherapies)andlaterelapses(>3priortherapies).?EarlyRelapses:pThefollowingregimensweremovedfromOtherRecommendedtoPreferred:?Isatuximab-irfc/carfilzomib/dexamethasone(category1)?Daratumumab/pomalidomide/dexamethasone(category1)?Footnoteadded:Regimensincludedunder1-3priortherapiescanalsobeusedlaterinthediseasecourse/Attemptshouldbemadetousedrugs/drugclassesthepatientshavenotbeenexposedtoorexposedto>1lineprior.?Footnoteadded:Autologousstemcelltransplantshouldbeconsideredinaneligiblepatientwhohadnotpreviouslyreceivedtransplantorhadaprolongedresponsetoinitialtransplant.MYEL-G4of4pUsefulinCertainCircumstances:?Fifthbulletrevised:High-doseorfractionatedcyclophosphamideMYEL-I1of3?Newsectionadded:ManagementofVenousThromboembolism(VTE)inMultipleMyelomaMGRS-1?InitialWorkuppRenalBiopsyrecommendedif:?Secondbulletrevised:eGFR<60mL/minand>2ml/minperyeardeclinepConsiderrenalbiopsyif:?Secondbulletrevised:eGFR<60mL/minand><2mL/minperyeardecline?Thirdbulletremoved:Proteinuria?FourthBulletrevised:Albumin:creatinine3-30mg/mmolorandGFR<60mL/minMGNS-1?InitialWorkuppFirstbullet,ninthsub-bulletrevised:Evaluationforlightchainamyloidosis,ifappropriate(SeeNCCNGuidelinesforSystemicLightChainAmyloidosis),WM(SeeNCCNGuidelinesforWM),orPOEMS(SeePOEMS-1),ifappropriate.Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version5.2022,03/09/22?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.UPDATESfunctiontests,albumin,bcalcium,serumuricacid,serumLDH,bandbeta-2microglobulinb?Creatinineclearance(calculatedormeasureddirectly)c?Serumquantitativeimmunoglobulins,serumproteinelectrophoresis(SPEP),serumimmunofixationelectrophoresis(SIFE)?24-hurinefortotalprotein,urineproteinelectrophoresis(UPEP),andurineimmunofixationelectrophoresisfunctiontests,albumin,bcalcium,serumuricacid,serumLDH,bandbeta-2microglobulinb?Creatinineclearance(calculatedormeasureddirectly)c?Serumquantitativeimmunoglobulins,serumproteinelectrophoresis(SPEP),serumimmunofixationelectrophoresis(SIFE)?24-hurinefortotalprotein,urineproteinelectrophoresis(UPEP),andurineimmunofixationelectrophoresis(UIFE)?Serumfreelightchain(FLC)assay?Whole-bodylow-doseCTscanorFDGPET/CTd,e?Unilateralbonemarrowaspirateandbiopsy,includingimmunohistochemistry(IHC)and/ormulti-parameterflowcytometry?Plasmacellfluorescenceinsituhybridization(FISH)bpanelonbonemarrowf[del13,del17p13,t(4;14),t(11;14),t(14;16),t(14:20),1q21gain/amplification,1pdeletion]generationsequencingNGSpanelonwf?Considerbaselinecloneidentificationandstorageofaspiratesampleforfutureminimalresidualdisease(MRD)testingbyNGS?Assessforcirculatingplasmacellsasclinicallyindicated?Historyandphysicalexam(H&P)?CBC,differential,plateletcount?Peripheralbloodsmear?SerumBUN/creatinine,electrolytes,liverryYELryYELingicgmacganceseelogicalanceseeesinicalficancedexINITIALDIAGNOSTICWORKUPaCLINICALFINDINGSinCircumstances?Ifwhole-bodylow-doseCTorFDGPET/CTisnegative,considerwhole-bodyMRIwithoutcontrasttodiscernsmolderingmyelomafromMM?Tissuebiopsytoconfirmsuspectedplasmacytoma?Plasmacellproliferation?Serumviscosity?HLAtyping?HepatitisBandHepatitisCtestingandHIVscreeningasrequired?Echocardiogram?Evaluationforlightchainamyloidosis,ifappropriate(SeeNCCNGuidelinesforryYELryYELarrayonbonemarrow,fand/arrayonbonemarrow,fand/ornext-aFrailtyassessmentshouldbeconsideredinolderadults.SeeNCCNGuidelinesforOlderAdultOncology.bThesetestsareessentialforR-ISSstaging.SeeStagingSystemsforMultipleMyeloma(MYEL-A).cSeeManagementofRenalDiseaseinMultipleMyeloma(MYEL-J).ebodydSkeletalsurveyisacceptableincertaincircumstances.However,ebodyFDGPET/CTorlow-doseCThasbeenperformed,thenskeletalsurveyisnotneeded.eSeePrinciplesofImaging(MYEL-B).fCD138positiveselectedsampleisstronglyrecommendedforoptimizedyield.gSeeDefinitionsofSmolderingandMultipleMyeloma(MYEL-C).Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.MYEL-1Version5.2022,03/09/22?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.FOLLOW-UP/SURVEILLANCEPrintedbyMinTangon3/14/20227:04:15AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.FOLLOW-UP/SURVEILLANCEdexCLINICALFINDINGSPRIMARYTREATMENTSolitaryplasmacytomaorSolitaryplasmacytomawithminimaliijRTk±RTk±orConsideral?Follow-upinterval,every3–6mo:mpCBC,differential,plateletcountpSerumchemistryforcreatinine,albumin,andcorrectedcalcium?Testsasneeded:pSerumquantitativeimmunoglobulins,SPEP,withSIFEp24-hurinefortotalproteinandUPEPwithUIFEpSerumFLCassaypSerumLDHandbeta-2microglobulinpBonemarrowaspirateandbiopsypAllplasmacytomasshouldbeimagedyearly,agnosisforatleastyearseagnosisforatleastyearseh?SeeNCCNGuidelinesforSurvivorshipPrimaryprogressivenorResponsefollowedbyprogressionnithyelomaorkupSeeMultiplemyeloma(symptomatic)(MYEL-4)eSeePrinciplesofImaging(MYEL-B).hWhole-bodyMRI(orPET/CTifMRIisnotavailable)isthefirstchoiceforinitialevaluationofsolitaryosseousplasmacytoma(MRIofthespineandpelvis,whole-bodyPET/CT,orlow-dosewhole-bodyCTundercertaincircumstances).Whole-bodyPET/CTisthefirstchoiceforinitialevaluationofsolitaryextraosseousplasmacytoma.iAllcriteriamustbepresentforthediagnosis.Fordiagnosticcriteria,pleaserefertoRajkumarSV,etal.LancetOncol2014;15:e538-e548.jSolitaryplasmacytomawith10%ormoreclonalplasmacellsisregardedasactive(symptomatic)MMandsystemictherapyshouldbeconsidered.kSeePrinciplesofRadiationTherapy(MYEL-D).lConsidersurgeryifstructurallyunstableorifthereisneurologiccompromiseduetomasseffect.mPatientswithsofttissueandhead/neckplasmacytomacouldbefollowedlessfrequentlyafterinitial3-monthfollow-up.nSeeResponseCriteriaforMultipleMyeloma(MYEL-E).Note:Allrecommendationsarecategory2Aunlessotherwiseindicated.ClinicalTrials:NCCNbelievesthatthebestmanagementofanypatientwithcancerisinaclinicaltrial.Participationinclinicaltrialsisespeciallyencouraged.Version5.2022,03/09/22?2021NationalComprehensiveCancerNetwork(NCCN),Allrightsreserved.NCCNGuidelinesandthisillustrationmaynotbereproducedinanyformwithouttheexpresswrittenpermissionofNCCN.MYEL-2FOLLOW-UP/SURVEILLANCEPrintedbyMinTangon3/14/20227:04:15AM.Forpersonaluseonly.Notapprovedfordistribution.Copyright?2022NationalComprehensiveCancerNetwork,Inc.,AllRightsReserved.FOLLOW-UP/SURVEILLANCEdexCLINICALFINDINGSPRIMARYTREATMENTSmolderingicicgLowriskoHighrisko,qialpintervalsq(category1)Observeatintervalsq(category1)ialpObserveat3-mointervalsasLenalidomideinselectpatients(category2B)?Every3–6months:pCBC,differential,plateletcountpCreatinine,correctedcalciumpSerumquantitativeimmunoglobulins,SPEP,SIFEp24-hurinefortotalprotein,UPEP,andUIFEatbaselineandasclinicallyindicatedo