Who manages multiple myeloma?

Who Manages Multiple Myeloma

Multiple myeloma should be managed through collaborative care between hematologists/oncologists with myeloma expertise and community-based oncologists, with hematologists serving as the primary specialists directing treatment decisions. 1

Primary Management Team

Hematologists are the core specialists managing multiple myeloma. The Italian Society of Hematology, Italian Society of Experimental Hematology, and Italian Group for Bone Marrow Transplantation specifically developed comprehensive guidelines for MM management, establishing hematology as the primary specialty 1. The Mayo Clinic consensus guidelines similarly reflect recommendations from myeloma physicians, reinforcing that hematology/oncology specialists with myeloma expertise should direct care 1.

Collaborative Care Model

Co-management between community oncologists and myeloma specialists at high-volume centers produces superior outcomes. 1, 2 This collaborative approach is essential because:

• Patients treated at high-volume myeloma centers have demonstrably better outcomes due to subspecialization and access to myeloma-specific resources 1
• Over 25% of US patients live more than 2 hours from centers offering advanced therapies like CAR-T, making pure academic center management impractical 1
• The complexity of modern MM therapy requires longitudinal partnerships between the primary oncologist (who knows the patient best) and the myeloma specialist (who knows evolving treatment intricacies best) 1, 2

Essential Interdisciplinary Team Members

Beyond hematologists, optimal MM management requires:

• Advanced practice providers (APPs) for day-to-day management and patient education 1
• Pharmacists for dose optimization and drug interaction management 1
• Nurses specialized in infusion therapy and immune effector cell complications 1
• Primary care physicians who remain essential for ongoing comorbidity management and initial diagnosis 1
• Transplant specialists for autologous stem cell transplantation in eligible patients 1
• Financial navigators to address barriers to care and medication access 1

When Specialist Referral is Critical

Immediate referral to a myeloma specialist is warranted for:

• Newly diagnosed patients under age 65 without severe comorbidities who are candidates for autologous stem cell transplantation 1
• High-risk disease defined by del(17p), t(14;16), t(14;20), t(4;14), or gain(1q) requiring specialized treatment approaches 3, 4
• Relapsed/refractory disease requiring consideration of novel therapies including bispecific antibodies, CAR-T therapy, or clinical trials 1, 2
• Aggressive presentations including spinal cord compression, rapidly progressive renal failure, or plasma cell leukemia requiring urgent cytoreduction 1

Telehealth and Remote Consultation Strategies

For patients with geographic barriers, telehealth co-management can bridge the gap. The VA medical system demonstrates success allowing patients to attend subspecialty telehealth appointments while physically located within their local community clinic 1. Physician-to-physician "curbside" consultation services can facilitate expert input for community oncologists managing stable patients 1.

Patient Navigation Resources

Direct-to-patient telephone support lines provide critical navigation assistance, particularly for patients with limited digital literacy or internet access 1. Key organizations include the International Myeloma Foundation (1-800-452-2873), Multiple Myeloma Research Foundation (1-888-841-6673), and Leukemia & Lymphoma Society (1-800-955-4572) 1.

Common Pitfalls in MM Management

Avoid these critical errors:

• Do not manage MM without hematology/oncology expertise, as the disease requires specialized knowledge of evolving treatment strategies and dose optimization techniques not typically included in package inserts 1
• Do not delay specialist consultation for high-risk features or relapsed disease, as early access to novel therapies and clinical trials significantly impacts outcomes 1
• Do not overlook the need for multidisciplinary support services including financial navigation, as socioeconomic barriers directly impact treatment access and outcomes 1