Dr Kumar on Key Treatment Considerations for Myeloma Following NCCN Guideline Updates

“When you have a newly diagnosed patient with myeloma, doing imaging to make sure you make an accurate diagnosis of myeloma vs one of the precursive conditions [is important].”

Shaji Kumar, MD, research chair, consultant, Division of Hematology, professor, medicine, Mayo Clinic, discusses notable therapy considerations for multiple myeloma following the 2024 and first quarter of 2025 National Comprehensive Cancer Network (NCCN) guidelines update.

The new NCCN guideline updates for myeloma management introduce several significant clarifications and enhancements, aiming to refine patient treatment and optimize outcomes, Kumar begins. A key emphasis is the early consideration of CAR T-cell therapy referrals, according to Kumar. Ensuring timely referral prevents delays in collecting lymphocytes and stem cells, which can hinder therapeutic efficacy in later disease stages, he emphasizes. Additionally, the updated guidelines provide greater specificity regarding radiotherapy, outlining precise dosing and highlighting clinical scenarios where radiation may be beneficial or should be avoided, Kumar adds.

A major focus of the updated guidelines is infection prophylaxis, especially given the infection risks associated with immunotherapy, he continues. Updates include recommendations for intravenous immunoglobulin prophylaxis to better protect vulnerable patients, Kumar notes. In line with evolving clinical practice, the guidelines have phased out less commonly used regimens, such as those containing thalidomide or doxorubicin, reflecting a shift towards more modern and effective therapies, Kumar explains. Changes were also made regarding the categorization of regimens, with some moving between the“preferred” and “other recommended” sections, ensuring alignment with contemporary standards of care, he says.

For newly diagnosed patients, imaging remains critical for differentiating myeloma from precursor conditions and identifying concurrent amyloidosis when clinically suspected, he expands. Quadruplet regimens are highlighted in the guidelines for fit patients, particularly those proceeding to autologous stem cell transplantation, Kumar shares.

Furthermore, the use of immunotherapies in myeloma continues to expand, Kumar reports. Early discussions with patients about CAR T-cell therapy at the first relapse are encouraged, along with referrals to specialized centers, he says. Additionally, bispecific antibodies are expected to play a growing role in community practice, signaling a shift in how these innovative treatments are integrated into routine care, he concludes.