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Blood Res (2025) 60:9
Published online February 4, 2025
https://doi.org/10.1007/s44313-025-00055-9
© The Korean Society of Hematology
Evidence-based Korean guidelines for the clinical management of multiple myeloma: addressing 12 key clinical questions
Correspondence to : Kihyun Kim
kihyunkimk@gmail.com
© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM. In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treatment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, therapeutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.
Keywords Multiple myeloma, Guidelines, Meta-analysis, Treatment, Prognosis
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REVIEW
Blood Res 2025; 60():
Published online February 4, 2025 https://doi.org/10.1007/s44313-025-00055-9
Copyright © The Korean Society of Hematology.
Evidence-based Korean guidelines for the clinical management of multiple myeloma: addressing 12 key clinical questions
Sung-Hoon Jung1, Youngil Koh2, Min Kyoung Kim3, Jin Seok Kim4, Joon Ho Moon5, Chang-Ki Min6, Dok Hyun Yoon7, Sung-Soo Yoon2, Je-Jung Lee1, Chae Moon Hong8, Ka-Won Kang9, Jihyun Kwon10, Kyoung Ha Kim11, Dae Sik Kim12, Sung Yong Kim13, Sung-Hyun Kim14, Yu Ri Kim4, Young Rok Do15, Yeung-Chul Mun16, Sung-Soo Park6, Young Hoon Park16, Ho Jin Shin17, Hyeon-Seok Eom18, Sang Eun Yoon19, Sang Mee Hwang20, Won Sik Lee21, Myung-won Lee22, Jun Ho Yi23, Ji Yun Lee24, Ji Hyun Lee14, Ho Sup Lee25, Sung-Nam Lim26, Jihyang Lim27, Ho-Young Yhim28, Yoon Hwan Chang29, Jae-Cheol Jo30, Jinhyun Cho31, Hyungwoo Cho7, Yoon Seok Choi9, Hee jeong Cho5, Ari Ahn32, Jong Han Choi33, Hyun Jung Kim34 and Kihyun Kim19*
1 Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea. 2 Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. 3 Division of Hemato-Oncology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea. 4 Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea. 5 Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. 6 Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 7 Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 8 Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. 9 Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea. 10 Department of Internal Medicine, Hematology and Oncology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea. 11 Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea. 12 Division of Oncology & Hematology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea. 13 Hematology & Oncology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea. 14 Division of Hematology-Oncology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea. 15 Division of Hematology-Oncology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea. 16 Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea. 17 Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea. 18 Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang, Republic of Korea. 19 Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, Republic of Korea. 20 Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea. 21 Department of Internal Medicine, Hematology, Inje University Busan Paik Hospital, Busan, Republic of Korea. 22 Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea. 23 Division of Hematology-Oncology, Department of Medicine, Chung-Ang University, Seoul, Republic of Korea. 24 Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea. 25 Department of Internal Medicine, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea. 26 Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea. 27 Department of Laboratory Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 28 Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea. 29 Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. 30 Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea. 31 Division of Hematology-Oncology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea. 32 Department of Laboratory Medicine, College of Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea. 33 Department of Endocrine and Metabolism Medicine, Konkuk University Medical Center, Seoul, Republic of Korea. 34 Institute for Evidence-Based Medicine, Cochrane Korea College of Medicine, Korea University, Seoul, Republic of Korea.
Correspondence to:Kihyun Kim
kihyunkimk@gmail.com
© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Abstract
Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM. In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treatment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, therapeutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.
Keywords: Multiple myeloma, Guidelines, Meta-analysis, Treatment, Prognosis
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Summary of recommendations.
KQ1. Is a four-drug regimen more effective than a three-drug regimen for induction in patients with transplant-eligible MM?.
Recommendation.
Grade.
Level of evidence.
For patients with newly diagnosed transplant-eligible MM, a four-drug regimen as initial therapy is recommended over a three-drug regimen owing to its better response rate.
Should be considered.
(Do, conditional).
Moderate.
KQ2. Is continuous therapy superior to fixed-duration first-line therapy in newly diagnosed patients with transplant-ineligible MM?.
Recommendation.
Grade.
Level of evidence.
Maintaining first-line therapy is recommended for patients with newly diagnosed transplant-ineligible MM.
Should be considered.
(Do, conditional).
Moderate.
KQ3. Is initial or delayed ASCT more effective in patients with transplant-eligible MM?.
Recommendation.
Grade.
Level of evidence.
Upfront ASCT is recommended rather than delayed transplantation in patients with transplant-eligible MM.
Should be considered.
(Do, conditional).
Very low.
KQ4. Is tandem transplantation better in improving OS as to a single ASCT?.
Recommendation.
Grade.
Level of evidence.
Tandem ASCT generally does not lead to significant improvement in survival as compared to single ASCT and carries an increased risk of toxicity. Therefore, it is generally not recommended for patients with MM. However, it may be considered on a limited basis for high-risk MM.
May be considered.
(Do not, conditional).
Low.
KQ5. Does maintenance therapy after ASCT improve survival in patients with MM?.
Recommendation.
Grade.
Level of evidence.
In patients with MM, maintenance therapy after ASCT significantly improves PFS and OS. Therefore, maintenance therapy is recommended.
Should be considered.
(Do, conditional).
High.
KQ6. Does treatment during biochemical relapse improve survival as compared to treatment during symptomatic relapse in relapsed MM?.
Recommendation.
Grade.
Level of evidence.
In patients with relapsed MM, treatment at biochemical relapse is recommended over treatment at the onset of clinical symptoms.
Should be considered.
(Do, conditional).
Low.
KQ7. Is retreatment with previously effective agents a viable approach for relapsed MM?.
Recommendation.
Grade.
Level of evidence.
When no other treatments are effective for patients with relapse, reusing a previously effective drug may be a viable option.
Should be considered.
(Do, conditional).
Very low.
KQ8. Is the use of antibiotics or antivirals effective for preventing infections during initial induction therapy in patients with newly diagnosed MM?.
Recommendation.
Grade.
Level of evidence.
Prophylactic antibiotics are recommended during initial therapy in patients with newly diagnosed.
Should be considered.
(Do, conditional).
Very low.
Prophylactic antiviral agents are recommended during initial therapy in patients with newly diagnosed MM.
Should be considered.
(Do, conditional).
Moderate.
KQ9. Is the use of bone resorption inhibitors effective in MM treatment?.
Recommendation.
Grade.
Level of evidence.
The use of pamidronate and zoledronate is recommended for the prevention and delay of SREs in patients with active MM.
Is recommended.
(Do, strong).
Moderate.
Denosumab can be recommended for the prevention and delay of SREs in patients with active MM, as it is not inferior to zoledronate.
Should be considered.
(Do, conditional).
Low.
KQ10. Are FDG PET/CT or MRI useful for predicting prognosis of patients with newly diagnosed MM?.
Recommendation.
Grade.
Level of evidence.
In newly diagnosed MM, both FDG PET/CT and MRI have significant prognostic value; therefore, either imaging modality can be recommended for prognosis prediction.
Should be considered.
(Do, conditional).
Very low.
KQ11. Is the assessment of MRD useful in patients with newly diagnosed MM?.
Recommendation.
Grade.
Level of evidence.
In newly diagnosed MM, the assessment of MRD is recommended.
Should be considered.
(Do, conditional).
Very low.
KQ12. Is immediate treatment initiation beneficial in patients with high-risk smoldering MM?.
Recommendation.
Grade.
Level of evidence.
For high-risk asymptomatic MM, initiating treatment immediately is recommended to extend PFS and OS.
Should be considered.
(Do, conditional).
Low.
KQ key question, MM multiple myeloma, ASCT autologous stem cell transplantation, PFS progression-free survival, OS overall survival, SREs skeletal-related events, FDG PET/CT fluorodeoxyglucose positron emission tomography/computed tomography, MRI magnetic resonance imaging, MRD minimal residual disease.
-
Level of evidence.
Level of evidence.
Definition.
High.
Evidence from well-conducted randomized clinical trials or meta-analyses with low risk of bias in study design and conduct, or from observational studies with no bias in study design or conduct and a very large effect size.
Moderate.
Evidence from randomized clinical trials or meta-analyses with some bias in study design and conduct or from observational studies with no bias in study design or conduct and a large effect size.
Low.
Evidence from randomized clinical trials or meta-analyses with significant bias in study design and conduct or from observational studies with no bias in study design and conduct.
Very low.
Evidence from observational studies or case reports with bias in study design and conduct or from poorly organized observational studies.
-
Definition of recommendation grade.
Grade.
Strength.
Direction.
Definitions.
Is recommended.
Strong.
Do.
When the benefits of a treatment or test clearly outweigh the risks, burdens, and costs.
Should be considered.
Conditional.
When the benefits of a treatment or test likely outweigh the risks, burdens, and costs but are uncertain.
May be considered.
Conditional.
Do not.
When the risks, burdens, and costs of a treatment or test likely outweigh the benefits but are uncertain.
Is not recommended.
Strong.
When the risks, burdens, and costs of a treatment or test clearly outweigh the benefits.
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