• Hematology Disease Site Group. Imrie K, Makarski J, Esmail R, Meyer R. Optimal therapy for patients diagnosed with multiple myeloma and the role of high-dose chemotherapy and stem cell support [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2003 Oct [online update]. 35 p. (Practice guideline report; no. 6-6). [106 references]

• Autologous transplantation is recommended for patients with advanced-stage myeloma and good performance status. The evidence is strongest for patients under 65 years of age without significant renal dysfunction following hydration and remission-induction chemotherapy. Physicians must use their clinical judgment in recommending transplantation to patients over 65 years of age or those with renal impairment.
• There is insufficient evidence to recommend allogeneic transplantation as routine therapy for multiple myeloma. Patients who are potentially eligible for transplantation should be referred for transplant assessment early after diagnosis and should not be given extensive exposure to alkylating agents such as melphalan prior to the collection of stem cells. High-dose glucocorticoid-based regimens such as vincristine, doxorubicin (Adriamycin), dexamethasone (VAD) are preferable for such patients.
• Harvesting of autologous peripheral blood stem cells or bone marrow should be performed early in the patient’s treatment course. The best available data demonstrate that transplantation is most advantageous when performed as part of the initial therapy.
• No conclusions can be reached about the role of interferon alpha following transplantation at this time.
• For patients undergoing autologous stem cell transplantation as part of standard therapy, it is recommended that the transplantation regimen include melphalan 200 mg/m² without total body radiation.
• There is insufficient evidence to recommend a treatment plan that includes two transplants performed in succession (tandem transplantation) outside of a clinical trial.

None provided

The recommendations are supported by randomized controlled trials and meta-analyses.

• Hematology Disease Site Group. Imrie K, Makarski J, Esmail R, Meyer R. Optimal therapy for patients diagnosed with multiple myeloma and the role of high-dose chemotherapy and stem cell support [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2003 Oct [online update]. 35 p. (Practice guideline report; no. 6-6). [106 references]

Not applicable: The guideline was not adapted from another source.

2000 Dec 22 (revised 2003 Oct)

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Practice Guidelines Initiative (PGI) is the main project of the Program in Evidence-based Care (PEBC), a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

Provincial Hematology Disease Site Group

Members of the Hematology Disease Site Group disclosed potential conflict of interest information.

None available

This NGC summary was completed by ECRI on October 29, 2002. The information was verified by the guideline developer on November 15, 2002. This NGC summary was updated by ECRI on June 29, 2004. The information was verified by the guideline developer on July 19, 2004.