title: Management of multiple myeloma and related-disorders: guidelines from the Italian Society of Hematology (SIE), Italian Society of Experimental Hematology (SIES) and Italian Group for Bone Marrow Transplantation (GITMO).
abstract: OBJECTIVE
  Perceiving the need for rigorous recommendations to facilitate decisions concerning the management of patients with multiple myeloma (MM), the Italian Society of Hematology (SIE) and the two affiliate societies (SIES and GITMO) commissioned a project to develop guidelines for the therapy of MM using evidence-based knowledge and consensus formation techniques.
  
  
  METHODS
  After a comprehensive systematic review of 1,450 papers, an Expert Panel formulated and graded sixty recommendations according to the supporting evidence. Evidence gaps were filled with twenty-two consensus-based statements. High grade recommendations (grade A) are reported below.
  
  
  RESULTS
  Treatment should be immediately initiated in MM patients with related organ damage: those patients aged below 65 years who do not have severe co-morbidities should receive autologous stem cell transplantation, while patients not candidates for autologous stem cell transplantation should receive oral melphalan and prednisone. Interferon-a should not be associated with conventional chemotherapy, but it can be offered with or without steroids as a maintenance therapy to patients who have reached a plateau phase. High-dose dexamethasone-containing regimens or high-dose dexamethasone alone are recommended as a first-line therapy when cytoreduction is urgently required (i.e., MM with spinal cord compression or with rapidly progressive renal failure). MM patients with moderate-to-severe anemia should receive erythropoietin, while patients with bone disease or osteopenia should receive long-term bisphophonates. Recommendations for the management of the clinical manifestations caused by the monoclonal protein (i.e. hyperviscosity, cast nephropathy, AL amyloidosis) and of solitary bone and extramedullary plasmacytoma were also elaborated.
  
  
  CONCLUSIONS
  A substantial proportion of clinical care for MM can be guided by evidence-based treatment recommendations.
authors.affiliation: Laboratorio di Epidemiologia Clinica, IRCCS Policlinico S.Matteo, Pavia, Italy. barosig@smatteo.pv.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barosi
authors.forename: Mario
authors.initials: M
authors.lastname: Boccadoro
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.forename: Paolo
authors.initials: P
authors.lastname: Corradini
authors.forename: Monia
authors.initials: M
authors.lastname: Marchetti
authors.forename: Massimo
authors.initials: M
authors.lastname: Massaia
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Merlini
authors.forename: Patrizia
authors.initials: P
authors.lastname: Tosi
authors.forename: Sante
authors.initials: S
authors.lastname: Tura
mesh_terms: D003131:Combined Modality Therapy; D019468:Disease Management; D019317:Evidence-Based Medicine; D006801:Humans; D007558:Italy; D009101:Multiple Myeloma / Q000150:complications / Q000628:therapy*; D012955:Societies, Medical