Managing myeloma Managing myeloma

NICE Pathways bring together everything NICE says on a topic in an interactive flowchart. NICE Pathways are interactive and designed to be used online.

They are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:

http://pathways.nice.org.uk/pathways/myeloma NICE Pathway last updated: 26 May 2020

This document contains a single flowchart and uses numbering to link the boxes to the associated recommendations.

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 1 of 21

Managing myeloma Managing myeloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 2 of 21

1 Person with myeloma

No additional information

2 Interim treatment regimens during the COVID-19 pandemic

A table of NHS England interim treatment regimens gives possible alternative treatment options

for use during the COVID-19 pandemic to reduce infection risk. This may affect decisions for

people with cancer. See the COVID-19 rapid guideline: delivery of systemic anticancer

treatments for more details.

3 Information and support

Provide information and support to people with myeloma or primary plasma cell leukaemia and

their family members or carers (as appropriate) particularly at diagnosis, at the beginning and

end of each treatment, at disease progression and at transition to end of life care.

Consider providing the following information in an individualised manner to people with

myeloma and their family members or carers (as appropriate):

the disease process, relapse and remission cycle, and the person's overall prognosis

the treatment plan, including (if appropriate) the process and the potential benefits, risks and complications of stem cell transplantation

symptoms of myeloma and treatment-related side effects (including steroid-related side effects, infection and neuropathy)

lifestyle measures to optimise bone health and renal function

how to identify and report new symptoms (especially pain and spinal cord compression)

the role of supportive and palliative care

how to access peer support and patient support groups.

Explain the symptoms of neuropathy to people with myeloma, and encourage them to tell their

clinical team about any new, different or worsening neuropathic symptoms immediately.

Offer prompt psychological assessment and support to people with myeloma at diagnosis and

(as appropriate) at the beginning and end of each treatment, at disease progression and at

transition to end of life care.

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 3 of 21

Refer people who are assessed as needing further psychological support to psychological

services.

Advise family members or carers (as appropriate) about available support services at diagnosis,

at the beginning and end of each treatment, at disease progression and at transition to end of

life care.

See recommendations on communication and tailoring healthcare services for each patient in

the NICE Pathway on patient experience in adult NHS services.

See also NICE's recommendations on end of life care for people with life-limiting conditions and

medicines optimisation.

NICE has produced information for the public on myeloma.

4 Transplant-eligible patients: first-line treatment

Induction treatment

Bortezomib

The following recommendation is from NICE technology appraisal guidance on bortezomib for

induction therapy in multiple myeloma before high-dose chemotherapy and autologous stem cell

transplantation.

Bortezomib is recommended as an option within its marketing authorisation, that is, in

combination with dexamethasone, or with dexamethasone and thalidomide, for the induction

treatment of adults with previously untreated multiple myeloma, who are eligible for high-dose

chemotherapy with haematopoietic stem cell transplantation.

NICE has written information for the public on bortezomib.

Lenalidomide

NICE is unable to make a recommendation on lenalidomide (Revlimid) with bortezomib and

dexamethasone for untreated multiple myeloma in adults because Celgene did not provide an

evidence submission. We will review this decision if the company decides to make a

submission.

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 4 of 21

Stem cell transplantation

First autologous stem cell transplantation

Consider using frailty and performance status measures that include comorbidities to assess

the suitability of people with myeloma for first autologous stem cell transplant.

Do not use age or the level of renal impairment alone to assess the suitability of people with

myeloma for first autologous stem cell transplant.

Allogeneic stem cell transplantation

Take into account that only a small number of people with myeloma are suitable for allogeneic

stem cell transplantation.

When assessing whether people with myeloma are suitable for an allogeneic stem cell

transplant, take into account:

whether the person has chemosensitive disease

how many previous lines of treatment they have had

whether a fully HLA matched donor is available

how GvHD and other complications may get worse with age

the risk of higher transplant-related mortality and morbidity, versus the potential for long-term disease-free survival

improving outcomes with other newer treatments

the person's understanding of the procedure, and its risks and benefits.

Consider allogeneic stem cell transplantation as part of a clinical trial if one is available.

Letermovir

The following recommendations are from NICE technology appraisal guidance on letermovir for

preventing cytomegalovirus disease after a stem cell transplant.

Letermovir is recommended, within its marketing authorisation, as an option for preventing CMV

reactivation and disease after an allogeneic HSCT in adults who are seropositive for CMV. It is

recommended only if the company provides it according to the commercial arrangement.

See why we made the recommendations on letermovir.

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 5 of 21

NICE has written information for the public on letermovir.

5 Transplant-eligible patients: second-line therapy

Daratumumab with bortezomib and dexamethasone

The following recommendations are from NICE technology appraisal guidance on daratumumab

with bortezomib and dexamethasone for previously treated multiple myeloma.

Daratumumab plus bortezomib plus dexamethasone is recommended for use within the Cancer

Drugs Fund as an option for treating relapsed multiple myeloma in people who have had 1

previous treatment. It is recommended only if the conditions in the managed access agreement

for daratumumab plus bortezomib plus dexamethasone are followed.

This recommendation is not intended to affect treatment with daratumumab plus bortezomib

plus dexamethasone that was started in the NHS before this guidance was published. People

having treatment outside this recommendation may continue without change to the funding

arrangements in place for them before this guidance was published, until they and their NHS

clinician consider it appropriate to stop.

See why we made the recommendations on daratumumab with bortezomib and

dexamethasone

NICE has written information for the public on daratumumab with bortezomib and

dexamethasone.

Daratumumab with lenalidomide and dexamethasone

NICE is unable to make a recommendation about the use in the NHS of daratumumab with

lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma because

no evidence submission was received from Janssen-Cilag. The company has confirmed that it

does not intend to make a submission.

Pomalidomide

NICE is unable to make a recommendation on pomalidomide (Imnovid) with bortezomib and

dexamethasone for treating relapsed or refractory multiple myeloma in adults because Celgene

did not provide an evidence submission. We will review this decision if the company decides to

make a submission.

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 6 of 21

Elotuzumab

The NICE technology appraisal of elotuzumab for previously treated multiple myeloma was

terminated because no evidence submission was received from Bristol–Myers Squibb for the

technology. Therefore NICE was unable to make a recommendation about the use in the

NHS of elotuzumab for previously treated multiple myeloma, but will review this decision if the

company decides to make a submission.

6 Transplant-eligible patients: subsequent treatment

Daratumumab

The following recommendations are from NICE technology appraisal guidance on daratumumab

monotherapy for treating relapsed and refractory multiple myeloma.

Daratumumab monotherapy is recommended for use within the Cancer Drugs Fund as an

option for treating relapsed and refractory multiple myeloma in adults whose previous therapy

included a proteasome inhibitor and an immunomodulator, and whose disease progressed on

the last therapy, only if:

they have daratumumab after 3 previous therapies and

the conditions in the managed access agreement are followed.

This recommendation is not intended to affect treatment with daratumumab that was started in

the NHS before this guidance was published. People having treatment outside this

recommendation may continue without change to the funding arrangements in place for them

before this guidance was published until they and their NHS clinician consider it appropriate to

stop.

NICE has written information for the public on daratumumab monotherapy.

Ixazomib

The following recommendations are from NICE technology appraisal guidance on ixazomib with

lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma.

Ixazomib, with lenalidomide and dexamethasone, is recommended for use within the Cancer

Drugs Fund as an option for treating multiple myeloma in adults only if:

they have already had 2 or 3 lines of therapy and

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 7 of 21

the conditions in the managed access agreement for ixazomib are followed.

This recommendation is not intended to affect treatment with ixazomib that was started in the

NHS before this guidance was published. People having treatment outside this recommendation

may continue without change to the funding arrangements in place for them before this

guidance was published, until they and their NHS clinician consider it appropriate to stop.

See why we made the recommendations on ixazomib [See page 16].

NICE has written information for the public on ixazomib.

Pomalidomide

The following recommendations are from NICE technology appraisal guidance on pomalidomide

for multiple myeloma previously treated with lenalidomide and bortezomib.

Pomalidomide, in combination with low-dose dexamethasone, is recommended as an option for

treating multiple myeloma in adults at third or subsequent relapse; that is, after 3 previous

treatments including both lenalidomide and bortezomib, only when the company provides

pomalidomide with the discount agreed in the patient access scheme.

This guidance is not intended to affect the position of patients whose treatment with

pomalidomide was started within the NHS before this guidance was published. Treatment of

those patients may continue without change to whatever funding arrangements were in place

for them before this guidance was published until they and their NHS clinician consider it

appropriate to stop.

NICE has written information for the public on pomalidomide.

Lenalidomide

The following recommendations are from NICE technology appraisal guidance on lenalidomide

for the treatment of multiple myeloma in people who have received at least 2 prior therapies.

Lenalidomide in combination with dexamethasone is recommended, within its licensed

indication, as an option for the treatment of multiple myeloma only in people who have received

2 or more prior therapies. It is recommended only if the company provides lenalidomide

according to the commercial arrangement.

People currently receiving lenalidomide for the treatment of multiple myeloma, but who have not

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 8 of 21

received 2 or more prior therapies, should have the option to continue therapy until they and

their clinicians consider it appropriate to stop.

NICE has written information for the public on lenalidomide.

7 Transplant-ineligible patients: first-line treatment

Bortezomib and thalidomide

The following recommendations are from NICE technology appraisal guidance on bortezomib

and thalidomide for the first-line treatment of multiple myeloma.

Thalidomide in combination with an alkylating agent and a corticosteroid is recommended as an

option for the first-line treatment of multiple myeloma in people for whom high-dose

chemotherapy with stem cell transplantation is considered inappropriate.

Bortezomib in combination with an alkylating agent and a corticosteroid is recommended as an

option for the first-line treatment of multiple myeloma if:

high-dose chemotherapy with stem cell transplantation is considered inappropriate and

the person is unable to tolerate or has contraindications to thalidomide.

NICE has written information for the public on bortezomib and thalidomide.

Lenalidomide plus dexamethasone

The following recommendations are from NICE technology appraisal guidance on lenalidomide

plus dexamethasone for previously untreated multiple myeloma.

Lenalidomide plus dexamethasone is recommended as an option for previously untreated

multiple myeloma in adults who are not eligible for a stem cell transplant, only if:

thalidomide is contraindicated (including for pre-existing conditions that it may aggravate) or

the person cannot tolerate thalidomide, and

the company provides lenalidomide according to the commercial arrangement.

This recommendation is not intended to affect treatment with lenalidomide that was started in

the NHS before this guidance was published. People having treatment outside this

recommendation may continue without change to the funding arrangements in place for them

before this guidance was published, until they and their NHS clinician consider it appropriate to

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 9 of 21

stop.

See why we made the recommendations on lenalidomide plus dexamethasone.

NICE has written information for the public on lenalidomide and dexamethasone.

Lenalidomide with bortezomib and dexamethasone

NICE is unable to make a recommendation on lenalidomide (Revlimid) with bortezomib and

dexamethasone for untreated multiple myeloma in adults because Celgene did not provide an

evidence submission. We will review this decision if the company decides to make a

submission.

8 Transplant-ineligible patients: second-line therapy

Lenalidomide plus dexamethasone

The following recommendations are from NICE technology appraisal guidance on lenalidomide

plus dexamethasone for multiple myeloma after 1 treatment with bortezomib.

Lenalidomide plus dexamethasone is recommended as an option for treating multiple myeloma

in adults only if:

they have had only 1 previous therapy, which included bortezomib, and

the company provides it according to the commercial arrangement.

This recommendation is not intended to affect treatment with lenalidomide that was started in

the NHS before this guidance was published. People having treatment outside this

recommendation may continue without change to the funding arrangements in place for them

before this guidance was published, until they and their NHS clinician consider it appropriate to

stop.

See why we made the recommendations on lenalidomide plus dexamethasone.

NICE has written information for the public on lenalidomide and dexamethasone.

Daratumumab with bortezomib and dexamethasone

The following recommendations are from NICE technology appraisal guidance on daratumumab

with bortezomib and dexamethasone for previously treated multiple myeloma.

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 10 of 21

Daratumumab plus bortezomib plus dexamethasone is recommended for use within the Cancer

Drugs Fund as an option for treating relapsed multiple myeloma in people who have had 1

previous treatment. It is recommended only if the conditions in the managed access agreement

for daratumumab plus bortezomib plus dexamethasone are followed.

This recommendation is not intended to affect treatment with daratumumab plus bortezomib

plus dexamethasone that was started in the NHS before this guidance was published. People

having treatment outside this recommendation may continue without change to the funding

arrangements in place for them before this guidance was published, until they and their NHS

clinician consider it appropriate to stop.

See why we made the recommendations on daratumumab with bortezomib and

dexamethasone

NICE has written information for the public on daratumumab with bortezomib and

dexamethasone.

Carfilzomib

The following recommendations are from NICE technology appraisal guidance on carfilzomib for

previously treated multiple myeloma.

Carfilzomib in combination with dexamethasone is recommended as an option for treating

multiple myeloma in adults, only if:

they have had only 1 previous therapy, which did not include bortezomib and

the company provides carfilzomib with the discount agreed in the patient access scheme.

These recommendations are not intended to affect treatment with carfilzomib that was started in

the NHS before this guidance was published. People having treatment outside these

recommendations may continue without change to the funding arrangements in place for them

before this guidance was published, until they and their NHS clinician consider it appropriate to

stop.

NICE has written information for the public on carfilzomib.

Pomalidomide

NICE is unable to make a recommendation on pomalidomide (Imnovid) with bortezomib and

dexamethasone for treating relapsed or refractory multiple myeloma in adults because Celgene

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 11 of 21

did not provide an evidence submission. We will review this decision if the company decides to

make a submission.

Daratumumab

NICE is unable to make a recommendation about the use in the NHS of daratumumab with

lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma because

no evidence submission was received from Janssen-Cilag. The company has confirmed that it

does not intend to make a submission.

Elotuzumab

The NICE technology appraisal of elotuzumab for previously treated multiple myeloma was

terminated because no evidence submission was received from Bristol–Myers Squibb for the

technology. Therefore NICE was unable to make a recommendation about the use in the

NHS of elotuzumab for previously treated multiple myeloma, but will review this decision if the

company decides to make a submission.

9 Transplant-ineligible patients: subsequent treatment

Daratumumab

The following recommendations are from NICE technology appraisal guidance on daratumumab

monotherapy for treating relapsed and refractory multiple myeloma.

Daratumumab monotherapy is recommended for use within the Cancer Drugs Fund as an

option for treating relapsed and refractory multiple myeloma in adults whose previous therapy

included a proteasome inhibitor and an immunomodulator, and whose disease progressed on

the last therapy, only if:

they have daratumumab after 3 previous therapies and

the conditions in the managed access agreement are followed.

This recommendation is not intended to affect treatment with daratumumab that was started in

the NHS before this guidance was published. People having treatment outside this

recommendation may continue without change to the funding arrangements in place for them

before this guidance was published until they and their NHS clinician consider it appropriate to

stop.

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 12 of 21

NICE has written information for the public on daratumumab monotherapy.

Ixazomib

The following recommendations are from NICE technology appraisal guidance on ixazomib with

lenalidomide and dexamethasone for treating relapsed or refractory multiple myeloma.

Ixazomib, with lenalidomide and dexamethasone, is recommended for use within the Cancer

Drugs Fund as an option for treating multiple myeloma in adults only if:

they have already had 2 or 3 lines of therapy and

the conditions in the managed access agreement for ixazomib are followed.

This recommendation is not intended to affect treatment with ixazomib that was started in the

NHS before this guidance was published. People having treatment outside this recommendation

may continue without change to the funding arrangements in place for them before this

guidance was published, until they and their NHS clinician consider it appropriate to stop.

See why we made the recommendations on ixazomib [See page 16].

NICE has written information for the public on ixazomib.

Pomalidomide

The following recommendations are from NICE technology appraisal guidance on pomalidomide

for multiple myeloma previously treated with lenalidomide and bortezomib.

Pomalidomide, in combination with low-dose dexamethasone, is recommended as an option for

treating multiple myeloma in adults at third or subsequent relapse; that is, after 3 previous

treatments including both lenalidomide and bortezomib, only when the company provides

pomalidomide with the discount agreed in the patient access scheme.

This guidance is not intended to affect the position of patients whose treatment with

pomalidomide was started within the NHS before this guidance was published. Treatment of

those patients may continue without change to whatever funding arrangements were in place

for them before this guidance was published until they and their NHS clinician consider it

appropriate to stop.

NICE has written information for the public on pomalidomide.

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 13 of 21

Panobinostat

The following recommendations are from NICE technology appraisal guidance on panobinostat

for treating multiple myeloma after at least 2 previous treatments.

Panobinostat in combination with bortezomib and dexamethasone is recommended, within its

marketing authorisation, as an option for treating multiple myeloma, that is, for 'adult patients

with relapsed and/or refractory multiple myeloma who have received at least 2 prior regimens

including bortezomib and an immunomodulatory agent' when the company provides

panobinostat with the discount agreed in the patient access scheme.

NICE has written information for the public on panobinostat.

Lenalidomide

The following recommendations are from NICE technology appraisal guidance on lenalidomide

for the treatment of multiple myeloma in people who have received at least 2 prior therapies.

Lenalidomide in combination with dexamethasone is recommended, within its licensed

indication, as an option for the treatment of multiple myeloma only in people who have received

2 or more prior therapies. It is recommended only if the company provides lenalidomide

according to the commercial arrangement.

People currently receiving lenalidomide for the treatment of multiple myeloma, but who have not

received 2 or more prior therapies, should have the option to continue therapy until they and

their clinicians consider it appropriate to stop.

NICE has written information for the public on lenalidomide.

10 Preventing and managing complications

See Myeloma / Preventing and managing complications of myeloma

11 Patients with primary plasma cell leukaemia

Induction treatment

Consider bortezomib-based and/or lenalidomide-based combination induction chemotherapy for

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 14 of 21

people with primary plasma cell leukaemia.

Stem cell transplantation

Consider high-dose melphalan-based autologous stem cell transplantation for people with

primary plasma cell leukaemia if they are suitable.

Managing mManaging myyeloma eloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 15 of 21

Why we made the recommendations on ixazomib

Ixazomib, with lenalidomide and dexamethasone, has a marketing authorisation to treat multiple

myeloma in people who have already had 1 or more lines of therapy. But it is likely to be used

only for people who have already had 2 or 3 lines of therapy, for whom current treatment is

lenalidomide plus dexamethasone, so the appraisal focused on this population.

The main clinical trial is ongoing. For people who have already had 2 or 3 lines of therapy,

ixazomib (with lenalidomide and dexamethasone) increases the length of time they live without

their disease progressing, when compared with lenalidomide plus dexamethasone alone. It is

not yet clear whether ixazomib (with lenalidomide plus dexamethasone) prolongs life compared

with lenalidomide plus dexamethasone alone, but the initial results are promising.

Ixazomib does not meet NICE's criteria to be considered a life-extending treatment at the end of

life.

Ixazomib has the potential to be cost effective for people who have had 2 or 3 lines of therapy,

at the price agreed in a commercial access agreement as part of the managed access

agreement. But more evidence is needed to address the clinical uncertainties. It can therefore

be recommended for use within the Cancer Drugs Fund while further data are collected from the

clinical trial, and through the Systemic Anti-Cancer Therapy dataset.

For more information see the committee discussion in the NICE technology appraisal guidance

on ixazomib with lenalidomide and dexamethasone for treating relapsed or refractory multiple

myeloma.

Glossary

FDG PET-CT

fluorodeoxyglucose positron emission tomography CT

FISH

fluorescence in-situ hybridisation

GvHD

graft-versus-host disease

Managing mManaging myyelomaeloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 16 of 21

HLA

human leukocyte antigen

INR

international normalised ratio

ISS

international Staging System

LMWH

low molecular weight heparin

MDT

multidisciplinary team

MDTs

multidisciplinary teams

MGUS

monoclonal gammopathy of undetermined significance

smouldering myeloma

(asymptomatic myeloma which has no evidence of myeloma-related organ or tissue injury or a

myeloma defining event)

CMV

cytomegalovirus

HSCT

haematopoietic stem cell transplant

Managing mManaging myyelomaeloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 17 of 21

Sources

Myeloma: diagnosis and management (2016) NICE guideline NG35

Lenalidomide with bortezomib and dexamethasone for untreated multiple myeloma (terminated

appraisal) (2019) NICE technology appraisal 603

Pomalidomide with bortezomib and dexamethasone for treating relapsed or refractory multiple

myeloma (terminated appraisal) (2019) NICE technology appraisal 602

Letermovir for preventing cytomegalovirus disease after a stem cell transplant (2019) NICE

technology appraisal guidance 591

Lenalidomide plus dexamethasone for previously untreated multiple myeloma (2019) NICE

technology appraisal guidance 587

Lenalidomide plus dexamethasone for multiple myeloma after 1 treatment with bortezomib

(2019) NICE technology appraisal guidance 586

Daratumumab with bortezomib and dexamethasone for previously treated multiple myeloma

(2019) NICE technology appraisal guidance 573

Daratumumab monotherapy for treating relapsed and refractory multiple myeloma (2018) NICE

technology appraisal guidance 510

Ixazomib with lenalidomide and dexamethasone for treating relapsed or refractory multiple

myeloma (2018) NICE technology appraisal guidance 505

Carfilzomib for previously treated multiple myeloma (2017) NICE technology appraisal guidance

457

Daratumumab with lenalidomide and dexamethasone for treating relapsed or refractory multiple

myeloma (terminated appraisal) (2017) NICE technology appraisal 454

Elotuzumab for previously treated multiple myeloma (terminated appraisal) (2017) NICE

technology appraisal 434

Pomalidomide for multiple myeloma previously treated with lenalidomide and bortezomib (2017)

NICE technology appraisal guidance 427

Managing mManaging myyelomaeloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 18 of 21

Panobinostat for treating multiple myeloma after at least 2 previous treatments (2016) NICE

technology appraisal guidance 380

Bortezomib for induction therapy in multiple myeloma before high-dose chemotherapy and

autologous stem cell transplantation (2014) NICE technology appraisal guidance 311

Bortezomib and thalidomide for the first-line treatment of multiple myeloma (2011) NICE

technology appraisal guidance 228

Lenalidomide for the treatment of multiple myeloma in people who have received at least 2 prior

therapies (2009 updated 2019) NICE technology appraisal guidance 171

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful

consideration of the evidence available. When exercising their judgement, professionals and

practitioners are expected to take this guideline fully into account, alongside the individual

needs, preferences and values of their patients or the people using their service. It is not

mandatory to apply the recommendations, and the guideline does not override the responsibility

to make decisions appropriate to the circumstances of the individual, in consultation with them

and their families and carers or guardian.

Local commissioners and providers of healthcare have a responsibility to enable the guideline

to be applied when individual professionals and people using services wish to use it. They

should do so in the context of local and national priorities for funding and developing services,

and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to

advance equality of opportunity and to reduce health inequalities. Nothing in this guideline

should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable

health and care system and should assess and reduce the environmental impact of

implementing NICE recommendations wherever possible.

Managing mManaging myyelomaeloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 19 of 21

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after

careful consideration of the evidence available. When exercising their judgement, health

professionals are expected to take these recommendations fully into account, alongside the

individual needs, preferences and values of their patients. The application of the

recommendations in this interactive flowchart is at the discretion of health professionals and

their individual patients and do not override the responsibility of healthcare professionals to

make decisions appropriate to the circumstances of the individual patient, in consultation with

the patient and/or their carer or guardian.

Commissioners and/or providers have a responsibility to provide the funding required to enable

the recommendations to be applied when individual health professionals and their patients wish

to use it, in accordance with the NHS Constitution. They should do so in light of their duties to

have due regard to the need to eliminate unlawful discrimination, to advance equality of

opportunity and to reduce health inequalities.

Commissioners and providers have a responsibility to promote an environmentally sustainable

health and care system and should assess and reduce the environmental impact of

implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after

careful consideration of the evidence available. When exercising their judgement, healthcare

professionals are expected to take these recommendations fully into account. However, the

interactive flowchart does not override the individual responsibility of healthcare professionals to

make decisions appropriate to the circumstances of the individual patient, in consultation with

the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the recommendations, in

their local context, in light of their duties to have due regard to the need to eliminate unlawful

discrimination, advance equality of opportunity, and foster good relations. Nothing in this

interactive flowchart should be interpreted in a way that would be inconsistent with compliance

with those duties.

Managing mManaging myyelomaeloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 20 of 21

Commissioners and providers have a responsibility to promote an environmentally sustainable

health and care system and should assess and reduce the environmental impact of

implementing NICE recommendations wherever possible.

Managing mManaging myyelomaeloma NICE Pathways

MyMyelomaeloma© NICE 2020. All rights reserved. Subject to Notice of rights.

Page 21 of 21