Multiple myeloma
Also known as: MGUS · MM · plasma cell dyscrasia
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Treatment of Multiple Myeloma: ASCO Living Guideline, Version 2026.1.1
American Society of Clinical Oncology (ASCO) · 2026 · 2026.1.1
A living guideline, meaning it is revised on a rolling schedule as new evidence appears rather than reissued at long intervals. It covers systemic therapy for multiple myeloma, including smouldering disease, transplant-eligible and transplant-ineligible newly diagnosed disease, and relapsed or refractory disease. Version 2026.1.1 is an incremental update to the January 2026 ASCO-Ontario Health living guideline.
- Published as a living guideline updated on a regular schedule by a standing expert panel. source
- The underlying January 2026 ASCO-Ontario Health (Cancer Care Ontario) version covers smouldering myeloma, transplant-eligible, transplant-ineligible and relapsed disease. source
- Published in the Journal of Clinical Oncology in 2026, lead author Rahul Banerjee. source
EHA-EMN Evidence-Based Guidelines for diagnosis, treatment and follow-up of patients with multiple myeloma
European Hematology Association (EHA) and European Myeloma Network (EMN) · 2025
Supersedes the 2021 European Hematology Association (EHA) and European Society for Medical Oncology (ESMO) version
The 2025 EHA-EMN evidence-based guideline replaces the 2021 EHA-ESMO guideline as the European reference for multiple myeloma, covering smouldering, newly diagnosed and relapsed/refractory disease. It folds in prognostic tools that entered practice after 2021 and addresses the wave of novel regimens approved since.
- Scope spans smouldering myeloma (including candidates for early intervention), newly diagnosed disease, and relapsed or refractory disease. source
- It adopts the R2-ISS revised international staging system, and treats minimal residual disease, circulating plasma cells and mass-spectrometry monoclonal protein assessment as prognostic factors entering clinical practice. source
- It addresses 14 novel regimens approved by the EMA and/or FDA at the time of development, alongside contemporary immunotherapies and T-cell-mobilising approaches. source
- Adverse-event guidance covers bone disease, renal impairment, infections, cytokine-release syndrome and immune effector cell-associated neurotoxicity syndrome. source
US vs EU key differences
- The two documents use different publication models: ASCO issues a version-numbered living guideline (Version 2026.1.1) that is revised continuously as practice-changing evidence appears, whereas the European EHA-EMN guideline is a periodically republished document, the 2025 edition being the first full refresh of the 2021 European recommendations. source
- Scope differs substantially: the EHA-EMN 2025 guideline spans diagnosis, treatment and follow-up and adds practical guidance on bone disease, renal impairment, infection prophylaxis, cytokine-release syndrome and ICANS, while the ASCO living guideline confines itself to therapy across smouldering, transplant-eligible, transplant-ineligible and relapsed/refractory disease. source
- The European guideline formally adopts the R2-ISS staging system and treats minimal residual disease, circulating plasma cells and mass-spectrometry measurement of monoclonal protein as prognostic tools entering routine practice; the ASCO document sets no staging or prognostic framework and is instead organised around therapeutic decisions in each treatment setting. source
- Both sides of the Atlantic have converged on quadruplet induction: ASCO recommends daratumumab or isatuximab added to bortezomib, lenalidomide and dexamethasone for both transplant-eligible and suitable transplant-ineligible patients, and the EHA-EMN guideline names DaraVRd and IsaVRd as the new standard-of-care induction regimens. source
- On relapsed disease the European guideline is more prescriptive about sequencing, placing CAR-T products ahead of BCMA-directed antibody-drug conjugates and reserving bispecific T-cell engagers for progression after CAR-T, whereas ASCO offers a choice between triplet therapy and T-cell-redirecting therapy guided by general selection principles rather than a fixed order. source
What changed recently
- US2026.1.0 → 2026.1.12026-01-01
This living-guideline version bump revisits the evidence base from a February 2026 literature search and issues updated recommendations covering the teclistamab plus daratumumab combination; the preceding 2026.1.0 release had itself replaced the 2019 guideline by adding first-ever guidance on smoldering myeloma and incorporating CAR T-cell, bispecific antibody and antibody-drug conjugate options.
source ↗curation confidence 90% - EU2021 → 20252025-07-07
The EHA-EMN 2025 guideline replaced the 2021 EHA-ESMO guideline, adopting the R2-ISS staging system and adding minimal residual disease, circulating plasma cells and mass-spectrometry monoclonal protein as prognostic factors, alongside 14 novel EMA/FDA-approved regimens.
See the full update feed for changes across every system.