MM is complex and treatment aims may change throughout the disease course.

It’s important to note that MM is an incurable cancer, and nearly all patients will eventually relapse after each line of therapy.

Establish intent of treatment

For MM:

• to obtain deep remission for durable disease control
• to improve quality of life and/or longevity without expectation of deep remission
• symptom palliation.

For solitary plasmacytoma:

• potential cure.

Systemic therapy is administered in virtually all patients treated for MM and may include immunomodulatory drugs, proteasome inhibitors, chemotherapy, monoclonal antibodies and corticosteroids.

Autologous stem cell transplant (ASCT) is usually included as part of frontline therapy for transplant-eligible patients.

Radiation therapy can provide rapid local control of myeloma or plasmacytoma that is causing pain or acute organ compromise such as spinal cord compression. In patients with solitary bone plasmacytoma or solitary extramedullary plasmacytoma, radiation therapy alone can offer durable control, and potentially cure.

Palliative care

Early referral to palliative care can improve quality of life and in some cases survival. Referral should be based on need, not prognosis. For more information, visit the Palliative Care Australia website <www.palliativecare.org.au>.

Communication

The lead clinician and team’s responsibilities include:

• discussing treatment options with the patient, family and/or carer including the intent of treatment as well as risks and benefits
• discussing advance care planning with the patient, family and/or carer where appropriate
• communicating the treatment plan to the patient’s GP

Checklist

• Intent, risk and benefits of treatment discussed with the patient and/or carer
• Treatment plan discussed with the patient and/or carer and provided to GP
• Supportive care needs assessed and referrals to allied health services actioned as required
• Early referral to palliative care considered and advance care planning discussed with the patient and/or carer

Timeframe

Systemic therapy should begin within 2 weeks of diagnosis and staging. In cases with critical organ compromise or rapid clinical progression, treatment may need to start within 24 hours of diagnosis.

Radiation therapy should start within 24 hours of referral where possible for patients with acute critical organ compromise, with a maximum acceptable waiting time of 48 hours.

For symptomatic tumours, radiation therapy should start within 48 hours of referral, with a maximum acceptable waiting time of 14 days.

For solitary bone plasmacytoma or extramedullary plasmacytoma, radiation therapy should begin within 14 days of referral, with a maximum acceptable waiting time of 28 days.