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Expert Rev Hematol. 2018 Mar;11(3):219-237. doi: 10.1080/17474086.2018.1437345. Epub 2018 Feb 16.

The multiple myeloma treatment landscape: international guideline recommendations and clinical practice in Europe.

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a "Seràgnoli" Institute of Hematology and Medical Oncology , Bologna University School of Medicine , Bologna , Italy.
b Department of Clinical Therapeutics , National and Kapodistrian University of Athens School of Medicine , Athens , Greece.
c Department of Hematology and Hemotherapy , Hospital Son Llàtzer , Mallorca , Spain.
d Julius-Maximilians-University of Würzburg, and Department of Internal Medicine II , University Hospital Würzburg , Würzburg , Germany.
e Consultant Hematologist , Christie National Health Service Foundation Trust , Manchester , UK.
f University of Manchester , Manchester , UK.
g University Clinic for Internal Medicine III, and Laboratory of Immunological and Molecular Cancer Research (LIMCR), Third Medical Department , Paracelsus Medical University, and Salzburg Cancer Research Institute , Salzburg , Austria.
h Amgen (Europe) GmbH , Zug , Switzerland.


Guidelines provide recommendations on the management of multiple myeloma (MM), but there are no standard algorithms for the choice and sequencing of treatments. As a result, there is widespread variation in the interpretation and implementation of these guidelines. Areas covered: This review will cover: the real-world data on MM treatment patterns; the approved agents available for the treatment of MM; a comparative summary of the national and international clinical guidelines; a discussion on the impact reimbursement decisions have on treatment availability. Expert commentary: In the future, treatment choices may become even more complex as clonal heterogeneity is better understood in the context of response to treatment, and next-generation agents become available. Although information on real-world practice patterns can provide further guidance, to date, few studies have generated data on patients treated with the newer agents in real-world settings. Furthermore, the translation of guideline recommendations into clinical practice across Europe is inconsistent. Additional real-world data are therefore vital to understanding current clinical practice patterns, so that new agents can be effectively incorporated into existing treatment strategies. Such information may aid the development of better guidance, which will ultimately help to ensure that patients receive the best possible care.


Clinical practice; guidelines; multiple myeloma; real-world evidence; treatment sequence

[Indexed for MEDLINE]

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