Guidelines on the Diagnosis and Management of Multiple Myeloma
1. Methods
- Initiated by the UK Myeloma Forum and commissioned through the BCSH
- Review of key literature to 30th June 2001 including Cochrane database, Medline and Internet searches
- Recommendations made based on literature review and consensus of expert opinion
- Consultation with representatives of other specialties
- Involvement of patient advocate groups
- Presented at BSH Annual meeting, Bournemouth, March 2000 and UKMF Annual Clinical Meeting 8th June 2000; revised as necessary following feedback from these presentations
- Reviewed by MM Forum Executive & BCSH Committees
- For annual review by UK Myeloma Forum; updates will be published here and on the BSH/BCSH web-sites
- Planned full revision date July 2004
- A synopsis of these guidelines is being developed for patients with myeloma and will be available on the web-sites of the IMF(UK) and the UK Myeloma Forum (anticipated early 2002)
- Further guidelines will include the management of solitary plasmacytoma, AL amyloidosis, and standards for the use of imaging techniques in myeloma
The guidelines are intended to set out the key areas of strategy in the effective clinical management of myeloma. Levels of evidence and grades of recommendation are set out in Tables IA and IB below. Detailed chemotherapy protocols and dosages are not included; they are beyond the scope of this document.
It is a function of each cancer centre/network to provide the detailed information and local protocols needed for the safe organisation, delivery and management of chemotherapy and related clinical care.
Statements appearing on drug dosage in the text mainly concern dosages used in specific trials or in the context of adjustment for renal impairment. The authors of these guidelines have made extensive efforts to ensure that treatments, drugs and dosage regimens are accurate. However, changes in information resulting from continuing research and clinical experience, reasonable differences in opinions among authorities, and the possibility of human error in preparation of the text require the clinician to exercise individual judgement when making a clinical decision. He/she must check product information and drug dosages before prescribing or administration.
Table IA: Levels of Evidence
| Ia | Evidence obtained from meta-analysis of randomised controlled trials |
| 1b | Evidence obtained from at least one randomised controlled trial |
| IIa | Evidence obtained from at least one well-designed, non-randomised study, including phase II trials and case-control studies |
| IIb | Evidence obtained from at least one other type of well-designed, quasi-experimental study, i.e. studies without planned intervention, including observational studies |
| III | Evidence obtained from well-designed, non-experimental descriptive studies. Evidence obtained from meta-analysis or randomised controlled trials or phase II studies which is published only in abstract form |
| IV | Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities |
Table IB: Grades of Recommendation
| Grade A Evidence level Ia, Ib |
Recommendation based on at least one randomised controlled trial of good quality and consistency addressing specific recommendation |
| Grade B Evidence level IIa, IIb, III |
Recommendation based on well conducted studies but no randomised controlled trials on the topic of recommendation |
| Grade C Evidence level IV |
Evidence from expert committee reports and/or clinical experiences of respected authorities |