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25.9. Management of multiple myeloma in Asia: resource-stratified guidelines

Chapter 25
Section Contents

Resource-stratified guidelines from the Asian Myeloma Network were initially published in 2013 [593] and subsequently updated in 2018 [1210]. These recommendations take into consideration differing health care resources across Asian countries.

Diagnostic work-up

When limited resources are available, the recommended diagnostic tests to establish a diagnosis of MM include serum and urine electrophoresis and sFLC analysis. This testing algorithm is also recommended for resource-abundant facilities.

Disease monitoring

In resource-constrained facilities, it is recommended that response to treatment is defined according to IMWG uniform response criteria, which includes sFLC analysis (Section 25.3.5), but routine evaluation of MRD is not required. This is because access to novel agents and SCT is still not universal, and a conventional CR remains a desirable treatment goal that is attained by only a minority of patients.

In resource-abundant healthcare systems, response evaluation can include MRD assessment, which is based on PET-CT imaging and NGF and NGS tests.

Questions

  1. What algorithm do current guidelines recommend for the screening of suspected monoclonal gammopathies?

Answers

  1. sFLC assays are recommended for use in combination with serum protein electrophoresis (SPE) and serum immunofixation electrophoresis (sIFE). However, if AL amyloidosis is suspected a 24-hour urine should also be requested (Section 25.3.1).
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