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The treatment of multiple myeloma has dramatically improved in the past 10 years. The availability of new drugs has broadened chemotherapy options; however, complete remissions (CR) are infrequent, and cure is still rare. High-dose therapy followed by autologous or allogeneic stem cell transplant has emerged as a promising means to increase remission rates and improve survival. Autologous transplants have not always shown survival benefits in randomized studies because the majority of patients who undergo transplant relapse, and patients given conventional therapy can receive salvage transplants at the time of relapse. CR has been found to reliably predict survival and thus the efforts to improve remission rates using autologous transplant include tandem transplants, targeted radiation, cytoprotective agents, or posttransplant immunotherapy. Only allogeneic hematopoietic stem cell transplantation is potentially curative, because of an immunologic graft-versus-myeloma effect. High transplant-related mortality associated with allogeneic stem cell transplantation is currently the major limitation to wider use of this modality. Although patients who receive either allogeneic or autologous stem cell transplants for multiple myeloma have similar 3- to 5-year survivals, only allograft recipients appear to enjoy long-term disease-free survival. Promising approaches designed to improve the therapeutic index of allografts include the use of nonablative conditioning regimens, peripheral blood cells rather than bone marrow, graft engineering, and targeted conditioning therapies such as bone-seeking radioisotopes.

Oral mucositis (OM) has emerged as a common cause of dose delays and interruptions of cancer therapies such as multicycle chemotherapy, myeloablative chemotherapy, and radiotherapy with or without concurrent chemotherapy of head and neck cancer. Research into both preventive and management strategies has lagged behind research into the common cancer treatment–related morbidities of nausea, vomiting, and cytopenias. This disparity is related to the complex risk assessment of multifactorial patient and treatment factors and different techniques of rating mucositis. In addition, relatively few clinical trials have focused on mucositis as a specific outcome. Currently, the only effective preventive strategies include the use of palifermin to prevent OM in the setting of hematopoietic stem cell transplantation and oral cryotherapy used in conjunction with bolus 5-FU, melphalan, or edatrexate. For the most part, managing OM relies on supportive care and symptom palliation. However, OM is a common problem associated with significant patient morbidity and increased resource use. The magnitude of the problem demands innovative approaches based on expert judgment as evidence accumulates to support specific recommendations. To improve this situation, the NCCN convened a multidisciplinary task force to address key issues. This report integrates expert judgment with a review of key literature on risk assessment, prevention, and treatment strategies, and provides recommendations for the overall management of OM. (JNCCN 2008;6[Suppl 1]:S1–S21)

Patients with cancer are at increased risk for developing infectious complications during the course of their disease and treatment. The following sections of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Prevention and Treatment of Cancer-Related Infections provide an overview of the risk factors for infectious complications, recommendations for infectious risk categorization, and strategies for prevention of infections in high-risk patient populations with cancer. Individualized risk evaluation for infections and incorporation of preventative measures are essential components of the overall spectrum of cancer care, and may contribute to optimizing treatment outcomes for patients.

These NCCN Guidelines Insights highlight the important updates/changes specific to the management of Waldenström’s Macroglobulinemia/Lymphoplasmacytic Lymphoma. These include the addition of regimens containing novel agents as primary and salvage therapy options, inclusion of the updated summary of response categories and criteria from the sixth international workshop on Waldenström’s Macroglobulinemia, and a section on management of peripheral neuropathy in the accompanying discussion.

These NCCN Guidelines Insights highlight the important updates/changes specific to the management of relapsed or progressive disease in the 2013 version of the NCCN Clinical Practice Guidelines in Oncology for Multiple Myeloma. These changes include the addition of new regimens as options for salvage therapy and strategies to mitigate the adverse effects and risks associated with newer regimens for the treatment of multiple myeloma.