(A) Treatment principles
1. Patients with asymptomatic myeloma or D-S stage I can be observed and reviewed every 3 months.
2. Patients with symptomatic MM or myeloma without symptoms but who have developed myeloma-related sexual organ failure should be treated early.
3. Those aged ≤65 years who are suitable for autologous stem cell transplantation should avoid alkylating agents and nitrosoureas.
4. Those who are suitable for clinical trials should be considered to enter clinical trials.
(B) Treatment of patients with symptomatic MM or D-S stage II or above
1. Induction therapy: serum immunoglobulin quantification and M protein quantification, blood cell count, BUN, creatinine, blood calcium, bone marrow aspiration (bone marrow biopsy can be reviewed if clinically necessary) are reviewed once a month during induction therapy; serum free light chain detection is recommended (X-ray bone photograph, MRI, PET/CT can be reviewed for more than six months if no new site of bone pain occurs or the degree of bone pain worsens). In general, chemotherapy regimens need to be evaluated for disease efficacy at 3~4 courses (including new drug regimens can be advanced), and when the efficacy reaches MR or above (those who do not reach MR or above are considered primary drug resistance or NC and need to change treatment regimens) the original regimen can be used to continue treatment until the disease turns into plateau.
Those aged ≤ 65 years or suitable for autologous stem cell transplantation: one of the following most mainstream regimens can be selected for induction therapy for 4 courses, or those with less than 4 courses but have achieved PR and better efficacy can undergo stem cell mobilization collection. Anticoagulation may be used prophylactically in high-risk patients.
1. BD (bortezomib + dexamethasone)
2. PAD (bortezomib + adriamycin + dexamethasone)
3. BTD (bortezomib + thalidomide + dexamethasone)
Age >65 years or not suitable for autologous stem cell transplantation, and blood Cr≥176mmol/L: one of the following options can be chosen until PR or above is achieved.
1.PAD (bortezomib + adriamycin + dexamethasone)
2, BD (bortezomib + dexamethasone)
3.BTD (bortezomib + thalidomide + dexamethasone)
Age >65 years old or not suitable for autologous stem cell transplantation, blood Cr≤176mmol/L: In addition to the above options, you can also choose one of the following options until PR or above is achieved.
1. VMP (Vanco+Mafran+Prednisone)
2. MPT (Marfalan + dexamethasone + thalidomide)
2. Treatment of primary drug-resistant MM
① Switch to a new regimen that has not been used, and if PR or above can be obtained, autologous stem cell transplantation should be performed as soon as possible if conditions are suitable.
② Enter clinical trials if they are eligible.
3.Treatment of MM relapse
Relapse after chemotherapy
① Relapse within six months after remission, switch to a new regimen that has not been used before.
②For relapse more than six months after remission, the original regimen for inducing remission can be tried; if it is ineffective, switch to a new regimen not used before.
③Stem cell transplantation (autologous, allogeneic) for those with suitable conditions.