Myeloma: diagnosis and management

Recommendation ID: NG35/3
Question: Management of smouldering myeloma:- Which combinations of FISH, molecular technologies, bone marrow plasma cell percentage, whole-body imaging, immunophenotype, serum-free light-chain levels or ratio, Hevylite, paraprotein levels, immunoparesis, and International Staging System (ISS) are most effective at risk stratification for people with smouldering myeloma? What is the comparative effectiveness of fixed duration treatment (with or without bone-directed therapy), continuous treatment (with or without bone-directed therapy) and no treatment (with or without bone-directed therapy) for people with smouldering myeloma?
Any explanatory notes (if applicable): Why this is important:- Changes to the International Myeloma Working Group definitions of smouldering myeloma and myeloma have affected the risk stratification process for smouldering myeloma. It is unclear if the previous risk stratification approach remains valid. It is also unclear if earlier treatment will be of benefit to people with smouldering myeloma. This study should be a randomised multi-centre prospective trial for patients with newly diagnosed smouldering myeloma (as defined by the
International Myeloma Working Group 2014 classification). Outcomes of interest are time to biochemical and/or clinical progression, overall survival, adverse events, quality of life and resource use.

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Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	29/02/2016