The following guidelines are excerpted from Palumbo et al, International Myeloma Working Group Guidelines for the Management of Multiple Myeloma Patients Ineligible for Standard High-Dose Chemotherapy with Autologous Stem Cell Transplantation, Leukemia (2009), 1-15.

The most important feature of any clinical unit established to care for myeloma patients is the training and expertise of the medical staff. Below are the diagnostic and specialty services required to support treatment decision-making and patient management. Patient support services, though desirable hallmarks of a good specialty center, are not absolutely essential.


  • It is recommended that a special clinical unit be developed devoted to the treatment of MM, with clear policies and protocols for access to specific therapies and supportive services.
  • A minimum of two newly diagnosed patients per month should receive induction therapy to ensure appropriate skill and experience of health personnel.

Required expertise and services for management of patients with MM

Diagnostic services
  • Diagnostic hematology and hematopathology
  • Clinical biochemistry and immunology
  • Diagnostic radiology
Specialist services
  • Renal services, including rapid access to hemodialysis
  • Clinical oncology/radiotherapy
  • Orthopedic surgery
  • Neurosurgery
  • Accredited bone marrow/stem cell transplant center
Support services
  • Hematology/oncology nurse specialists
  • Palliative care physicians/nurses
  • Pharmacy with expertise and facilities for dispensing cytotoxic drugs
  • Physiotherapy/rehabilitation
  • Administration support for case registration, audit, and clinical trials
  • Patient information including information available social services and financial advise
  • Patient support group
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