{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T16:37:45Z","timestamp":1789231065224,"version":"build-2803163510"},"reference-count":122,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"10","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["J Clin Oncol"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"\n \n \n This guideline has been updated.<\/jats:bold>\n <\/jats:p>\n \n This ASCO Living Guideline is reviewed on an eight-week cycle. Please see the\n online dynamic version<\/jats:ext-link>\n for the latest updates.\n <\/jats:p>\n <\/jats:boxed-text>\n <\/jats:p>\n \n ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the<\/jats:italic>\n \n ASCO Guidelines Methodology Manual<\/jats:italic>\n <\/jats:ext-link>\n . ASCO Guidelines follow the<\/jats:italic>\n \n ASCO Conflict of Interest Policy for Clinical Practice Guidelines<\/jats:italic>\n <\/jats:ext-link>\n .\n <\/jats:p>\n \n \n Clinical Practice Guidelines and other guidance (\u201cGuidance\u201d) provided by ASCO is not a comprehensive or definitive guide to treatment options. It is intended for voluntary use by clinicians and should be used in conjunction with independent professional judgment. Guidance may not be applicable to all patients, interventions, diseases or stages of diseases. Guidance is based on review and analysis of relevant literature, and is not intended as a statement of the standard of care. ASCO does not endorse third-party drugs, devices, services, or therapies and assumes no responsibility for any harm arising from or related to the use of this information. See complete disclaimer in\n Appendix 1<\/jats:xref>\n and\n Appendix 2<\/jats:xref>\n (online only) for more\n <\/jats:italic>\n .\n <\/jats:p>\n \n PURPOSE<\/jats:title>\n To provide updated guidance regarding the therapy for multiple myeloma.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n ASCO and Ontario Health (Cancer Care Ontario) convened a joint Expert Panel and conducted an updated systematic review of the literature.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The updated review identified a total of 161 relevant randomized trials.<\/jats:p>\n <\/jats:sec>\n \n UPDATED RECOMMENDATIONS<\/jats:title>\n Daratumumab therapy may be offered to patients with high-risk smoldering myeloma. Quadruplet therapy with daratumumab or isatuximab, combined with bortezomib, lenalidomide, and dexamethasone, should be offered as initial therapy for transplant eligible patients. They should also be offered at least lenalidomide maintenance, with or without daratumumab, carfilzomib, and\/or dexamethasone. Quadruplet therapy with daratumumab or isatuximab, combined with bortezomib, lenalidomide, and dexamethasone, should be offered as therapy for suitable transplant-ineligible patients. Patients with relapsed or refractory multiple myeloma should be offered triplet therapy or T-cell redirecting therapies according to a set of recommended principles.<\/jats:p>\n \n Additional information is available at\n www.asco.org\/hematologic-malignancies-guidelines<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1200\/jco-25-02587","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T21:00:26Z","timestamp":1767733226000},"page":"914-941","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":10,"title":["Treatment of Multiple Myeloma: ASCO\u2013Ontario Health (Cancer Care Ontario) Living Guideline"],"prefix":"10.1200","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1858-7420","authenticated-orcid":false,"given":"Lisa K.","family":"Hicks","sequence":"first","affiliation":[{"name":"St Michael's Hospital & University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4585-9906","authenticated-orcid":false,"given":"Hans J.","family":"Messersmith","sequence":"additional","affiliation":[{"name":"American Society of Clinical Oncology (ASCO), Alexandria, VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4297-8042","authenticated-orcid":false,"given":"Samer","family":"Al Hadidi","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3781-5441","authenticated-orcid":false,"given":"Rahul","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Center, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4070-1819","authenticated-orcid":false,"given":"Benjamin A.","family":"Derman","sequence":"additional","affiliation":[{"name":"University of Chicago, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5392-9284","authenticated-orcid":false,"given":"Shaji","family":"Kumar","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1479-7626","authenticated-orcid":false,"given":"Tanya M.","family":"Wildes","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center\/Nebraska Medicine, Omaha, NE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8206-8919","authenticated-orcid":false,"given":"Susan","family":"Bal","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sita","family":"Bhella","sequence":"additional","affiliation":[{"name":"Princess Margaret Cancer Centre, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Chmielewski","sequence":"additional","affiliation":[{"name":"Health Tree Foundation, Trenton, NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Costello","sequence":"additional","affiliation":[{"name":"UC San Diego Moores Cancer Center, La Jolla, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raetasha","family":"Dabney","sequence":"additional","affiliation":[{"name":"Texas Oncology, Grapevine, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7277-0061","authenticated-orcid":false,"given":"Monique","family":"Hartley-Brown","sequence":"additional","affiliation":[{"name":"Dana Farber Cancer Institute, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Langerak","sequence":"additional","affiliation":[{"name":"Arizona Oncology, Prescott, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7596-2015","authenticated-orcid":false,"given":"Brea","family":"Lipe","sequence":"additional","affiliation":[{"name":"James P. 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