title: European Myeloma Network guidelines for the management of multiple myeloma-related complications.
abstract: The European Myeloma Network provides recommendations for the management of the most common complications of multiple myeloma. Whole body low-dose computed tomography is more sensitive than conventional radiography in depicting osteolytic disease and thus we recommend it as the novel standard for the detection of lytic lesions in myeloma (grade 1A). Myeloma patients with adequate renal function and bone disease at diagnosis should be treated with zoledronic acid or pamidronate (grade 1A). Symptomatic patients without lytic lesions on conventional radiography can be treated with zoledronic acid (grade 1B), but its advantage is not clear for patients with no bone involvement on computed tomography or magnetic resonance imaging. In asymptomatic myeloma, bisphosphonates are not recommended (grade 1A). Zoledronic acid should be given continuously, but it is not clear if patients who achieve at least a very good partial response benefit from its continuous use (grade 1B). Treatment with erythropoietic-stimulating agents may be initiated in patients with persistent symptomatic anemia (hemoglobin <10g/dL) in whom other causes of anemia have been excluded (grade 1B). Erythropoietic agents should be stopped after 6-8 weeks if no adequate hemoglobin response is achieved. For renal impairment, bortezomib-based regimens are the current standard of care (grade 1A). For the management of treatment-induced peripheral neuropathy, drug modification is needed (grade 1C). Vaccination against influenza is recommended; vaccination against streptococcus pneumonia and hemophilus influenza is appropriate, but efficacy is not guaranteed due to suboptimal immune response (grade 1C). Prophylactic aciclovir (or valacyclovir) is recommended for patients receiving proteasome inhibitors, autologous or allogeneic transplantation (grade 1A).
authors.affiliation: Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece eterpos@med.uoa.gr.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Terpos
authors.affiliation: Department of Hematology and Oncology, University of Freiburg Medical Center, Germany Clinic for Internal Medicine, University Hospital Basel, Switzerland.
authors.forename: Martina
authors.initials: M
authors.lastname: Kleber
authors.affiliation: Department of Hematology and Oncology, University of Freiburg Medical Center, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Engelhardt
authors.affiliation: Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Sonja
authors.initials: S
authors.lastname: Zweegman
authors.affiliation: Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gay
authors.affiliation: Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece.
authors.forename: Efstathios
authors.initials: E
authors.lastname: Kastritis
authors.affiliation: Department of Hematology, University Medical Center, Utrecht, the Netherlands.
authors.forename: Niels W C J
authors.initials: NW
authors.lastname: van de Donk
authors.affiliation: Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.affiliation: Department of Hematology, Memorial Sisli Hospital, Istanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Sezer
authors.affiliation: Department of Hematology, Erasmus University Medical Center Rotterdam, the Netherlands.
authors.forename: Annemiek
authors.initials: A
authors.lastname: Broijl
authors.affiliation: Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Bringhen
authors.affiliation: Department of Hematology, Ankara University, Turkey.
authors.forename: Meral
authors.initials: M
authors.lastname: Beksac
authors.affiliation: Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Larocca
authors.affiliation: Department of Hemato-Oncology, University Hospital Ostrava and Faculty of Medicine OU, Ostrava, Czech Republic.
authors.forename: Roman
authors.initials: R
authors.lastname: Hajek
authors.affiliation: Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture, Italy.
authors.forename: Pellegrino
authors.initials: P
authors.lastname: Musto
authors.affiliation: Department of Hematology, Aalborg University Hospital, Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Johnsen
authors.affiliation: Department of Hematology, Azienda Ospedaliera dell'Annunziata, Cosenza, Italy.
authors.forename: Fortunato
authors.initials: F
authors.lastname: Morabito
authors.affiliation: Department of Medicine I, Center of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria.
authors.forename: Heinz
authors.initials: H
authors.lastname: Ludwig
authors.affiliation: "Seràgnoli" Institute of Hematology and Medical Oncology, University of Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.affiliation: Department of Internal Medicine II, University Hospital Würburg, Würzburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.affiliation: Department of Hematology, Erasmus University Medical Center Rotterdam, the Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Sonneveld
authors.affiliation: Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece.
authors.forename: Meletios A
authors.initials: MA
authors.lastname: Dimopoulos
authors.affiliation: Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
mesh_terms: D000740:Anemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D001847:Bone Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D019468:Disease Management; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D009101:Multiple Myeloma / Q000150:complications*; D059408:Pain Management; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000628:therapy