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Myelomatose

Myelomatose

Sist oppdatert: 21.12.2023
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Utgiver: Helsedirektoratet
Versjon: 1.0
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Anbefalinger:

  • Diagnose og behandlingsindikasjon settes etter 2014-kriteriene, og krever biopsi av enten benmarg eller plasmacytom.
  • Risikostratifisering av utredningen anbefales med FISH, ISS og R-ISS.
  • Høydosebehandling med stamcellestøtte anbefales som en del av førstelinjebehandlingen hos pasienter under 70 år uten betydelig komorbiditet.
  • For pasienter over 70 år eller med betydelig komorbiditet, anbefales VRd.
  • Det anbefales å endre behandling ved biokjemisk tilbakefall eller klinisk tilbakefall.
  • Anbefalte behandlingslinjer: Velcade-Revlimid-dex => Daratumumab-Velcade dex => Karfilzomib-dex => Pomaolidomid-dex => Belantamabmafodotin
  • Det anbefales zoledronsyre 4 mg i.v. hver 4. uke i 2 år. Hvis pasienten oppnår VGPR kan behandling avsluttes etter minst 1 års behandling. Deretter eventuelt re-oppstart ved skjelettprogresjon.
    • Denosumab kan vurderes ved kontraindikasjon for zoledronsyre.

Referanser 

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