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Haematologica. 2015 Oct;100(10):1254-66. doi: 10.3324/haematol.2014.117176.

European Myeloma Network guidelines for the management of multiple myeloma-related complications.

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Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
Department of Hematology and Oncology, University of Freiburg Medical Center, Germany Clinic for Internal Medicine, University Hospital Basel, Switzerland.
Department of Hematology and Oncology, University of Freiburg Medical Center, Germany.
Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands.
Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy.
Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece.
Department of Hematology, University Medical Center, Utrecht, the Netherlands.
Department of Hematology, Memorial Sisli Hospital, Istanbul, Turkey.
Department of Hematology, Erasmus University Medical Center Rotterdam, the Netherlands.
Department of Hematology, Ankara University, Turkey.
Department of Hemato-Oncology, University Hospital Ostrava and Faculty of Medicine OU, Ostrava, Czech Republic.
Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture, Italy.
Department of Hematology, Aalborg University Hospital, Denmark.
Department of Hematology, Azienda Ospedaliera dell'Annunziata, Cosenza, Italy.
Department of Medicine I, Center of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria.
"Seràgnoli" Institute of Hematology and Medical Oncology, University of Bologna, Italy.
Department of Internal Medicine II, University Hospital Würburg, Würzburg, Germany.


The European Myeloma Network provides recommendations for the management of the most common complications of multiple myeloma. Whole body low-dose computed tomography is more sensitive than conventional radiography in depicting osteolytic disease and thus we recommend it as the novel standard for the detection of lytic lesions in myeloma (grade 1A). Myeloma patients with adequate renal function and bone disease at diagnosis should be treated with zoledronic acid or pamidronate (grade 1A). Symptomatic patients without lytic lesions on conventional radiography can be treated with zoledronic acid (grade 1B), but its advantage is not clear for patients with no bone involvement on computed tomography or magnetic resonance imaging. In asymptomatic myeloma, bisphosphonates are not recommended (grade 1A). Zoledronic acid should be given continuously, but it is not clear if patients who achieve at least a very good partial response benefit from its continuous use (grade 1B). Treatment with erythropoietic-stimulating agents may be initiated in patients with persistent symptomatic anemia (hemoglobin <10g/dL) in whom other causes of anemia have been excluded (grade 1B). Erythropoietic agents should be stopped after 6-8 weeks if no adequate hemoglobin response is achieved. For renal impairment, bortezomib-based regimens are the current standard of care (grade 1A). For the management of treatment-induced peripheral neuropathy, drug modification is needed (grade 1C). Vaccination against influenza is recommended; vaccination against streptococcus pneumonia and hemophilus influenza is appropriate, but efficacy is not guaranteed due to suboptimal immune response (grade 1C). Prophylactic aciclovir (or valacyclovir) is recommended for patients receiving proteasome inhibitors, autologous or allogeneic transplantation (grade 1A).

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