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<meta name="robots" content="NOINDEX,NOFOLLOW,NOARCHIVE,NOIMAGEINDEX" /><meta name="author" content="National Collaborating Centre for Cancer (UK)" /><meta name="citation_title" content="Myeloma" /><meta name="citation_publisher" content="National Institute for Health and Care Excellence (UK)" /><meta name="citation_date" content="2016/02" /><meta name="citation_author" content="National Collaborating Centre for Cancer (UK)" /><meta name="citation_pmid" content="26913316" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK344101/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Myeloma" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Institute for Health and Care Excellence (UK)" /><meta name="DC.Contributor" content="National Collaborating Centre for Cancer (UK)" /><meta name="DC.Date" content="2016/02" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK344101/" /><meta name="description" content="The management of myeloma is complex and challenging. It increasingly involves the use of expensive drugs. The guideline will aim to raise standards nationally while allowing clinical flexibility and defining a common pathway for patients at various stages of their illness, and of different ages and levels of fitness. Although a consistent approach to management is desirable, it needs to reflect the very different groups of patients with myeloma from the fit and suitable for transplant, fairly fit but not suitable for transplant to patients who are extremely frail and/or unwell." /><meta name="og:title" content="Myeloma" /><meta name="og:type" content="book" /><meta name="og:description" content="The management of myeloma is complex and challenging. It increasingly involves the use of expensive drugs. The guideline will aim to raise standards nationally while allowing clinical flexibility and defining a common pathway for patients at various stages of their illness, and of different ages and levels of fitness. Although a consistent approach to management is desirable, it needs to reflect the very different groups of patients with myeloma from the fit and suitable for transplant, fairly fit but not suitable for transplant to patients who are extremely frail and/or unwell." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK344101/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng35-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="warning" content="In October 2018 recommendations 1.8.13 to 1.8.17 were replaced by NICE's guideline on venous thromboembolism in over 16s (NG89)." /><meta name="bk-non-canon-loc" content="/books/n/niceng35/toc/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK344101/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p></div><div class="bk_msg_box bk_bttm_mrgn clearfix bk_noprnt"><div class="iconblock clearfix"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/niceng35guid/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng35guid-lrg.png" alt="Cover" height="100px" width="80px" /></a><div class="icnblk_cntnt"><ul class="messages"><li class="info icon"><span class="icon"><a href="/books/n/niceng35guid/">See 2018 Partial Update</a></span></li></ul></div></div></div><div class="messagearea bk_noprnt" style="margin-bottom:1.3846em "><ul class="messages"><li class="warn icon"><span class="icon">In October 2018 recommendations 1.8.13 to 1.8.17 were replaced by NICE's guideline on venous thromboembolism in over 16s (NG89).</span></li></ul></div><div class="bk_prnt"><p style="color:red;"><strong>In October 2018 recommendations 1.8.13 to 1.8.17 were replaced by NICE's guideline on venous thromboembolism in over 16s (NG89).</strong></p></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="http://www.nice.org.uk/" title="National Institute for Health and Care Excellence (UK)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng35-lrg.png" alt="Cover of Myeloma" /></a><div class="icnblk_cntnt"><h1 id="_NBK344101_"><span itemprop="name">Myeloma</span></h1><div class="subtitle">Diagnosis and Management</div><p><i>NICE Guideline, No. 35</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Collaborating Centre for Cancer (UK)</span>.</p><div class="half_rhythm">London: <a href="http://www.nice.org.uk/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (UK)</span></a>; <span itemprop="datePublished">2016 Feb</span>.</div><div><a href="/books/about/copyright/">Copyright</a> © National Collaborating Centre for Cancer.</div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div itemprop="description"><h2>Excerpt</h2><p>The management of myeloma is complex and challenging. It increasingly involves the use of expensive drugs. The guideline will aim to raise standards nationally while allowing clinical flexibility and defining a common pathway for patients at various stages of their illness, and of different ages and levels of fitness. Although a consistent approach to management is desirable, it needs to reflect the very different groups of patients with myeloma from the fit and suitable for transplant, fairly fit but not suitable for transplant to patients who are extremely frail and/or unwell.</p></div><div><h2>Contents</h2><ul id="toc_tllNBK344101_toc_fm_s1" class="simple-list toc toc-toggle"><li class="half_rhythm" id="toc_itm_NBK344101_toc_fm_s1"><a class="toc-item" href="/books/n/niceng35/fm.s1/">Key research recommendations</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_fm_s2"><a class="toc-item" href="/books/n/niceng35/fm.s2/">Methodology</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_fm_s38"><a class="toc-item" href="/books/n/niceng35/fm.s38/">Algorithm</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_fm_s39"><a class="toc-item" href="/books/n/niceng35/fm.s39/">Epidemiology</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch1"><a class="toc-item" href="/books/n/niceng35/ch1/">1. Communication and Support</a><ul id="toc_lst_NBK344101_toc_ch1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch1_s1"><a class="toc-item" href="/books/n/niceng35/ch1/#ch1.s1">Clinical evidence</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch1_s5"><a class="toc-item" href="/books/n/niceng35/ch1/#ch1.s5">Cost-effectiveness evidence</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch1_rl1"><a class="toc-item" href="/books/n/niceng35/ch1/#ch1.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch2"><a class="toc-item" href="/books/n/niceng35/ch2/">2. Laboratory investigations</a><ul id="toc_lst_NBK344101_toc_ch2" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch2_s1"><a class="toc-item" href="/books/n/niceng35/ch2/#ch2.s1">2.1. Laboratory investigations for people with suspected myeloma</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch2_s18"><a class="toc-item" href="/books/n/niceng35/ch2/#ch2.s18">2.2. Laboratory investigations to provide prognostic information</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch2_rl1"><a class="toc-item" href="/books/n/niceng35/ch2/#ch2.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch3"><a class="toc-item" href="/books/n/niceng35/ch3/">3. Imaging investigations</a><ul id="toc_lst_NBK344101_toc_ch3" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch3_s1"><a class="toc-item" href="/books/n/niceng35/ch3/#ch3.s1">3.1. Imaging for people with suspected myeloma</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch3_s30"><a class="toc-item" href="/books/n/niceng35/ch3/#ch3.s30">3.2. Imaging for people with newly diagnosed myeloma</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch3_rl1"><a class="toc-item" href="/books/n/niceng35/ch3/#ch3.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch4"><a class="toc-item" href="/books/n/niceng35/ch4/">4. Smouldering myeloma</a><ul id="toc_lst_NBK344101_toc_ch4" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch4_s1"><a class="toc-item" href="/books/n/niceng35/ch4/#ch4.s1">Clinical evidence</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch4_s8"><a class="toc-item" href="/books/n/niceng35/ch4/#ch4.s8">Cost-effectiveness evidence</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch4_rl1"><a class="toc-item" href="/books/n/niceng35/ch4/#ch4.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch5"><a class="toc-item" href="/books/n/niceng35/ch5/">5. Service organisation</a><ul id="toc_lst_NBK344101_toc_ch5" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch5_s1"><a class="toc-item" href="/books/n/niceng35/ch5/#ch5.s1">Clinical evidence (see also Appendix G)</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch5_s2"><a class="toc-item" href="/books/n/niceng35/ch5/#ch5.s2">Cost effectiveness evidence</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch6"><a class="toc-item" href="/books/n/niceng35/ch6/">6. Managing newly diagnosed myeloma</a><ul id="toc_lst_NBK344101_toc_ch6" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch6_s1"><a class="toc-item" href="/books/n/niceng35/ch6/#ch6.s1">6.1. First-line treatment</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch6_s25"><a class="toc-item" href="/books/n/niceng35/ch6/#ch6.s25">6.2. Primary plasma cell leukaemia</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch6_rl1"><a class="toc-item" href="/books/n/niceng35/ch6/#ch6.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch7"><a class="toc-item" href="/books/n/niceng35/ch7/">7. Managing acute renal disease caused by myeloma</a><ul id="toc_lst_NBK344101_toc_ch7" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch7_s1"><a class="toc-item" href="/books/n/niceng35/ch7/#ch7.s1">Clinical evidence</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch7_s18"><a class="toc-item" href="/books/n/niceng35/ch7/#ch7.s18">Cost effectiveness evidence</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch7_rl1"><a class="toc-item" href="/books/n/niceng35/ch7/#ch7.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch8"><a class="toc-item" href="/books/n/niceng35/ch8/">8. Preventing and managing bone disease</a><ul id="toc_lst_NBK344101_toc_ch8" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch8_s1"><a class="toc-item" href="/books/n/niceng35/ch8/#ch8.s1">8.1. Preventing bone disease</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch8_s16"><a class="toc-item" href="/books/n/niceng35/ch8/#ch8.s16">8.2. Managing non-spinal bone disease</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch8_s22"><a class="toc-item" href="/books/n/niceng35/ch8/#ch8.s22">8.3. Managing spinal bone disease</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch8_rl1"><a class="toc-item" href="/books/n/niceng35/ch8/#ch8.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch9"><a class="toc-item" href="/books/n/niceng35/ch9/">9. Preventing and managing complications</a><ul id="toc_lst_NBK344101_toc_ch9" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch9_s1"><a class="toc-item" href="/books/n/niceng35/ch9/#ch9.s1">9.1. Preventing infection</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch9_s18"><a class="toc-item" href="/books/n/niceng35/ch9/#ch9.s18">9.2. Managing peripheral neuropathy</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch9_s26"><a class="toc-item" href="/books/n/niceng35/ch9/#ch9.s26">9.3. Preventing thrombosis</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch9_s35"><a class="toc-item" href="/books/n/niceng35/ch9/#ch9.s35">9.4. Managing fatigue</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch9_rl1"><a class="toc-item" href="/books/n/niceng35/ch9/#ch9.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch10"><a class="toc-item" href="/books/n/niceng35/ch10/">10. Monitoring</a><ul id="toc_lst_NBK344101_toc_ch10" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch10_s1"><a class="toc-item" href="/books/n/niceng35/ch10/#ch10.s1">Clinical evidence</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch10_s5"><a class="toc-item" href="/books/n/niceng35/ch10/#ch10.s5">Cost effectiveness evidence</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch10_rl1"><a class="toc-item" href="/books/n/niceng35/ch10/#ch10.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch11"><a class="toc-item" href="/books/n/niceng35/ch11/">11. Managing relapsed myeloma</a><ul id="toc_lst_NBK344101_toc_ch11" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch11_s1"><a class="toc-item" href="/books/n/niceng35/ch11/#ch11.s1">11.1. First relapse</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch11_s2"><a class="toc-item" href="/books/n/niceng35/ch11/#ch11.s2">11.2. Second autologous stem cell transplant</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch11_s7"><a class="toc-item" href="/books/n/niceng35/ch11/#ch11.s7">11.3. Subsequent therapy</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_ch11_rl1"><a class="toc-item" href="/books/n/niceng35/ch11/#ch11.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_appendixes_appgroup1"><a class="toc-item" href="/books/n/niceng35/appendixes.appgroup1/">Appendices</a><ul id="toc_lst_NBK344101_toc_appendixes_appgroup1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK344101_toc_appa"><a class="toc-item" href="/books/n/niceng35/appa/">Appendix A. The cost effectiveness of alternate imaging strategies for diagnosis in secondary care of patients with suspected myeloma</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_appb"><a class="toc-item" href="/books/n/niceng35/appb/">Appendix B. The cost-effectiveness of balloon kyphoplasty and vertebroplasty compared to non-surgical management for the treatment of vertebral collapse in patients with myeloma</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_appc"><a class="toc-item" href="/books/n/niceng35/appc/">Appendix C. Abbreviations</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_appd"><a class="toc-item" href="/books/n/niceng35/appd/">Appendix D. Glossary</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_appe"><a class="toc-item" href="/books/n/niceng35/appe/">Appendix E. Guideline scope</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_appf"><a class="toc-item" href="/books/n/niceng35/appf/">Appendix F. People and organisations involved in producing the guideline</a></li><li class="half_rhythm" id="toc_itm_NBK344101_toc_appg"><a class="toc-item" href="/books/n/niceng35/appg/">Appendix G. Evidence review</a></li></ul></li></ul></div><div>
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<b>Funding:</b> Funded to produce guidelines for the NHS by NICE
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</div><div><p><b>Disclaimer:</b> Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © National Collaborating Centre for Cancer.</div><div class="small"><span class="label">Bookshelf ID: NBK344101</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26913316" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26913316</a></span></div><div style="margin-top:2em" class="bk_noprnt"><div class="pagination bk_noprnt"><span class="inactive page_link prev">< Prev</span><a class="active page_link next" href="/books/n/niceng35/fm.s1/" title="Next page in this title">Next ></a></div></div></div></div>
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<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-toc&ncbi_acc=NBK344101&ncbi_domain=niceng35&ncbi_report=printable&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK344101/?report=printable&ncbi_app=bookshelf" /></noscript>
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<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/3400083/3426610.js" snapshot="books"></script></body>
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