After initial diagnostic workup, What are the clinical findings?
--If Multiple Myeloma (symptomatic), Perform primary treatment through myeloma therapy. Is the patient a transplant candidate?
----If Yes, Is the patient frail?
------If No (frail score <2), Does the patient have either renal insufficiency or peripheral neuropathy?
--------If No, Is the patient standard or high risk?
----------If Standard risk, The treatments for the patient are Bortezomib/Lenalidomide/Dexamethasone combination or Carfilzomib/Lenalidomide/Dexamethasone or Carfilzomib/Lenalidomide/Bortezomib/Dexamethasone or Ixazomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------If High Risk, The treatments for the patient are Daratumumab/Carfilzomib/Lenalidomide/Dexamethasone or Daratumumab/Cyclophosphamide/Bortezomib/Dexamethasone or Daratumumab/Bortezomib/Thalidomide/Dexamethasone or VTD-PACE. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------If Yes, Does the patient have acute renal insufficiency or have chronic renal insufficiency and/or peripheral neuropathy?
----------If Chronic Renal insufficiency and/or Peripheral Neuropathy, The treatments for the patient are Carfilzomib/Cyclophosphamide/Dexamethasone or Ixazomib/Cyclophosphamide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------If Acute Renal Insufficiency, The initial treatment for the patient is Bortezomib/Cyclophosphamide/Dexamethasone. After improvement of the renal function, the treatment for the patient is Bortezomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
------If Yes (frail score >=2), The treatments for the patient are Bortezomib/Dexamethasone or Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
--------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
--------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
----------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
----------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
--------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
--------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
----------------If No, Patient is treated.
----------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
--------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
--------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
----------------If No, Patient is treated.
----------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----If No, Is the patient frail?
------If Yes (frail score >=2), The treatments for the patient are Bortezomib/Dexamethasone or Lenalidomide/Dexamethasone.With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
--------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
--------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
----------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
----------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
--------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
--------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
----------------If No, Patient is treated.
----------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
--------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
--------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
----------------If No, Patient is treated.
----------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
------If No (frail score <2), Does the patient have either renal insufficiency or peripheral neuropathy?
--------If No, The treatments for the patient are Bortezomib/Lenalidomide/Dexamethasone or Daratumumab/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------If No, Patient is treated.
------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------If No, Patient is treated.
------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------If Yes, Does the patient have acute renal insufficiency or have chronic renal insufficiency and/or peripheral neuropathy?
----------If Chronic Renal insufficiency and/or Peripheral Neuropathy, The treatments for the patient are Carfilzomib/Cyclophosphamide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------If Acute Renal Insufficiency, The initial treatment for the patient is Bortezomib/Cyclophosphamide/Dexamethasone. After improvement of the renal function, the treatment for the patient is Bortezomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--If Smoldering myeloma (asymptomatic), Is it high risk or low risk?
----If Low Risk, Perform primary treatment through a clinical trial OR observe at 3- to 6-month intervals (category 1). For follow-up/surveillance, every 3-6 months keep track of: CBC, differential, platelet count. Creatinine, corrected calcium. Serum quantitative, immunoglobulins, SPEP, SIFE. 24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels. Serum FLC assay. Bone marrow aspirate and biopsy with FISH, SNP array, NGS, or multi-parameter flow cytometry as needed. Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as needed, ideally with the same technique used at diagnosis. After, identify if there is progression to symptomatic myeloma. Is there progression to symptomatic myeloma?
------If No, patient is treated.
------If Yes, Clinical findings presented are multiple myeloma. Perform myeloma therapy, beginning with Is the patient a transplant candidate?
--------If Yes, Is the patient frail?
----------If No (frail score <2), Does the patient have either renal insufficiency or peripheral neuropathy?
------------If No, Is the patient standard or high risk?
--------------If Standard risk, The treatments for the patient are Bortezomib/Lenalidomide/Dexamethasone combination or Carfilzomib/Lenalidomide/Dexamethasone or Carfilzomib/Lenalidomide/Bortezomib/Dexamethasone or Ixazomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If High Risk, The treatments for the patient are Daratumumab/Carfilzomib/Lenalidomide/Dexamethasone or Daratumumab/Cyclophosphamide/Bortezomib/Dexamethasone or Daratumumab/Bortezomib/Thalidomide/Dexamethasone or VTD-PACE. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
------------If Yes, Does the patient have acute renal insufficiency or have chronic renal insufficiency and/or peripheral neuropathy?
--------------If Chronic Renal insufficiency and/or Peripheral Neuropathy, The treatments for the patient are Carfilzomib/Cyclophosphamide/Dexamethasone or Ixazomib/Cyclophosphamide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If Acute Renal Insufficiency, The initial treatment for the patient is Bortezomib/Cyclophosphamide/Dexamethasone. After improvement of the renal function, the treatment for the patient is Bortezomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------If Yes (frail score >=2), The treatments for the patient are Bortezomib/Dexamethasone or Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------If No, Is the patient frail?
----------If Yes (frail score >=2), The treatments for the patient are Bortezomib/Dexamethasone or Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------If No (frail score <2), Does the patient have either renal insufficiency or peripheral neuropathy?
------------If No, The treatments for the patient are Bortezomib/Lenalidomide/Dexamethasone or Daratumumab/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
--------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
--------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
----------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
----------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
--------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
--------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
------------If Yes, Does the patient have acute renal insufficiency or have chronic renal insufficiency and/or peripheral neuropathy?
--------------If Chronic Renal insufficiency and/or Peripheral Neuropathy, The treatments for the patient are Carfilzomib/Cyclophosphamide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If Acute Renal Insufficiency, The initial treatment for the patient is Bortezomib/Cyclophosphamide/Dexamethasone. After improvement of the renal function, the treatment for the patient is Bortezomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----If High Risk, Perform primary treatment through a clinical trial (preferred) OR observe at 3-month intervals as clinically indicated OR use Lenalidomide in select patients (category 2B). For follow-up/surveillance, every 3-6 months keep track of: CBC, differential, platelet count. Creatinine, corrected calcium. Serum quantitative, immunoglobulins, SPEP, SIFE. 24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels. Serum FLC assay. Bone marrow aspirate and biopsy with FISH, SNP array, NGS, or multi-parameter flow cytometry as needed. Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as needed, ideally with the same technique used at diagnosis. After, identify if there is progression to symptomatic myeloma. Is there progression to symptomatic myeloma?
------If No, patient is treated.
------If Yes, Clinical findings presented are multiple myeloma. Perform myeloma therapy, beginning with Is the patient a transplant candidate?
--------If Yes, Is the patient frail?
----------If No (frail score <2), Does the patient have either renal insufficiency or peripheral neuropathy?
------------If No, Is the patient standard or high risk?
--------------If Standard risk, The treatments for the patient are Bortezomib/Lenalidomide/Dexamethasone combination or Carfilzomib/Lenalidomide/Dexamethasone or Carfilzomib/Lenalidomide/Bortezomib/Dexamethasone or Ixazomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
-----------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If High Risk, The treatments for the patient are Daratumumab/Carfilzomib/Lenalidomide/Dexamethasone or Daratumumab/Cyclophosphamide/Bortezomib/Dexamethasone or Daratumumab/Bortezomib/Thalidomide/Dexamethasone or VTD-PACE. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
------------If Yes, Does the patient have acute renal insufficiency or have chronic renal insufficiency and/or peripheral neuropathy?
--------------If Chronic Renal insufficiency and/or Peripheral Neuropathy, The treatments for the patient are Carfilzomib/Cyclophosphamide/Dexamethasone or Ixazomib/Cyclophosphamide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If Acute Renal Insufficiency, The initial treatment for the patient is Bortezomib/Cyclophosphamide/Dexamethasone. After improvement of the renal function, the treatment for the patient is Bortezomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------If Yes (frail score >=2), The treatments for the patient are Bortezomib/Dexamethasone or Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------If No, Is the patient frail?
----------If Yes (frail score >=2), The treatments for the patient are Bortezomib/Dexamethasone or Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------If No (frail score <2), Does the patient have either renal insufficiency or peripheral neuropathy?
------------If No, The treatments for the patient are Bortezomib/Lenalidomide/Dexamethasone or Daratumumab/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
--------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
--------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
----------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
----------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
--------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
--------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
------------If Yes, Does the patient have acute renal insufficiency or have chronic renal insufficiency and/or peripheral neuropathy?
--------------If Chronic Renal insufficiency and/or Peripheral Neuropathy, The treatments for the patient are Carfilzomib/Cyclophosphamide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If Acute Renal Insufficiency, The initial treatment for the patient is Bortezomib/Cyclophosphamide/Dexamethasone. After improvement of the renal function, the treatment for the patient is Bortezomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--If Solitary plasmacytoma, Perform primary treatment, either radiation therapy with the possibility of surgery or consider a clinical trial. Afterwards, have a follow-up interval for every 3–6 months to keep track of: CBC, differential, platelet count. Serum chemistry for creatinine, albumin, and corrected calcium. Also keep track of tests as needed: Serum quantitative immunoglobulins, SPEP, with SIFE. 24-h urine for total protein and UPEP with UIFE. Serum FLC assay. Serum LDH and beta-2 microglobulin. Bone marrow aspirate and biopsy. All plasmacytomas should be imaged yearly, preferably with the same technique used at diagnosis, for at least 5 years. After, identify if primary progressive or if there is a response followed by progression. Is there a response followed by progression or is there primary progressive?
------If No, patient is treated.
------If Yes, Restage with myeloma workup and obtain clinical findings presented as multiple myeloma. Perform myeloma therapy, beginning with Is the patient a transplant candidate?
--------If Yes, Is the patient frail?
----------If No (frail score <2), Does the patient have either renal insufficiency or peripheral neuropathy?
------------If No, Is the patient standard or high risk?
--------------If Standard risk, The treatments for the patient are Bortezomib/Lenalidomide/Dexamethasone combination or Carfilzomib/Lenalidomide/Dexamethasone or Carfilzomib/Lenalidomide/Bortezomib/Dexamethasone or Ixazomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If High Risk, The treatments for the patient are Daratumumab/Carfilzomib/Lenalidomide/Dexamethasone or Daratumumab/Cyclophosphamide/Bortezomib/Dexamethasone or Daratumumab/Bortezomib/Thalidomide/Dexamethasone or VTD-PACE. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
------------If Yes, Does the patient have acute renal insufficiency or have chronic renal insufficiency and/or peripheral neuropathy?
--------------If Chronic Renal insufficiency and/or Peripheral Neuropathy, The treatments for the patient are Carfilzomib/Cyclophosphamide/Dexamethasone or Ixazomib/Cyclophosphamide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If Acute Renal Insufficiency, The initial treatment for the patient is Bortezomib/Cyclophosphamide/Dexamethasone. After improvement of the renal function, the treatment for the patient is Bortezomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------If Yes (frail score >=2), The treatments for the patient are Bortezomib/Dexamethasone or Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------If No, Is the patient frail?
----------If Yes (frail score >=2), The treatments for the patient are Bortezomib/Dexamethasone or Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------If No, Patient is treated.
--------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------If No (frail score <2), Does the patient have either renal insufficiency or peripheral neuropathy?
------------If No, The treatments for the patient are Bortezomib/Lenalidomide/Dexamethasone or Daratumumab/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
--------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
--------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
----------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
----------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
--------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
--------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
------------If Yes, Does the patient have acute renal insufficiency or have chronic renal insufficiency and/or peripheral neuropathy?
--------------If Chronic Renal insufficiency and/or Peripheral Neuropathy, The treatments for the patient are Carfilzomib/Cyclophosphamide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If Acute Renal Insufficiency, The initial treatment for the patient is Bortezomib/Cyclophosphamide/Dexamethasone. After improvement of the renal function, the treatment for the patient is Bortezomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.

--If Monoclonal gammopathies of clinical significance, Is it Monoclonal Gammopathy of Renal Significance (MGRS) or Monoclonal Gammopathy of Neurological Significance (MGNS)?
----If MGRS, Evaluate for kidney disease by analyzing kidney function: eGFR, urinalysis and metabolic testing. Is AKI stage 3, eGFR <60 mL/min and >2ml/min per year decline, Proteinuria (>1 g/day), Albumin:creatinine >30mg/mmol, and Fanconi syndrome OR is AKI stage 1 or 2, eGFR <60 mL/min and <2 mL/min per year decline, Albumin:creatinine 3–30mg/mmol and GFR <60mL/min, Evidence of light chain proteinuria OR is eGFR stable, urinalysis normal and no evidence of light chain proteinuria?
------If eGFR stable, urinalysis normal and no evidence of light chain proteinuria, Defer renal biopsy.
------If AKI stage 3, eGFR <60 mL/min and >2ml/min per year decline, Proteinuria (>1 g/day), Albumin:creatinine >30mg/mmol, and Fanconi syndrome, Renal biopsy is recommended. After confirm diagnosis of MGRS by: Light microscopy. Immunofluorescence staining for IgG subclasses, IgA and IgM, and kappa and lambda Note: M protein detected in serum and/or urine must match the one found in the renal biopsy. Electron microscopy. PET/CT, low-dose CT, or whole-body MRI as clinically indicated. Bone marrow biopsy if suspected to have MM or WM. Do additional workup as clinically indicated. After, for treatment is MGRS lgG, lgA, or FLC MGRS?
--------If Yes, perform myeloma therapy, Is the patient a transplant candidate?
----------If Yes, Is the patient frail?
------------If No (frail score <2), Does the patient have either renal insufficiency or peripheral neuropathy?
--------------If No, Is the patient standard or high risk?
----------------If Standard risk, The treatments for the patient are Bortezomib/Lenalidomide/Dexamethasone combination or Carfilzomib/Lenalidomide/Dexamethasone or Carfilzomib/Lenalidomide/Bortezomib/Dexamethasone or Ixazomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------------If High Risk, The treatments for the patient are Daratumumab/Carfilzomib/Lenalidomide/Dexamethasone or Daratumumab/Cyclophosphamide/Bortezomib/Dexamethasone or Daratumumab/Bortezomib/Thalidomide/Dexamethasone or VTD-PACE. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If Yes, Does the patient have acute renal insufficiency or have chronic renal insufficiency and/or peripheral neuropathy?
----------------If Chronic Renal insufficiency and/or Peripheral Neuropathy, The treatments for the patient are Carfilzomib/Cyclophosphamide/Dexamethasone or Ixazomib/Cyclophosphamide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------------If Acute Renal Insufficiency, The initial treatment for the patient is Bortezomib/Cyclophosphamide/Dexamethasone. After improvement of the renal function, the treatment for the patient is Bortezomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
------------If Yes (frail score >=2), The treatments for the patient are Bortezomib/Dexamethasone or Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
--------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
--------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
----------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
----------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
--------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
--------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------If No, Is the patient frail?
------------If Yes (frail score >=2), The treatments for the patient are Bortezomib/Dexamethasone or Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
--------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
--------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
----------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
----------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
--------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
--------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
------------If No (frail score <2), Does the patient have either renal insufficiency or peripheral neuropathy?
--------------If No, The treatments for the patient are Bortezomib/Lenalidomide/Dexamethasone or Daratumumab/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If Yes, Does the patient have acute renal insufficiency or have chronic renal insufficiency and/or peripheral neuropathy?
----------------If Chronic Renal insufficiency and/or Peripheral Neuropathy, The treatments for the patient are Carfilzomib/Cyclophosphamide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------------If Acute Renal Insufficiency, The initial treatment for the patient is Bortezomib/Cyclophosphamide/Dexamethasone. After improvement of the renal function, the treatment for the patient is Bortezomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------If No, Is MGRS lgM MGRS or MGRS with monoclonal B-cell lymphocytosis (MBL) features?
----------If lgM MGRS, follow NCCN Guidlines for Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphomaa. After, use response criteria for WM. Then measure relapse and individualize treatment based on response and toxicity of prior therapy, patient’s performance status, and renal function at the time of relapse.
----------If MGRS with monoclonal B-cell lymphocytosis (MBL) features, follow NCCN Guidelines for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Then, evaluate renal function and bone marrow involvement or radiologic findings. After, measure relapse and individualize treatment based on response and toxicity of prior therapy, patient’s performance status, and renal function at the time of relapse.
------If AKI stage 1 or 2, eGFR <60 mL/min and <2 mL/min per year decline, Albumin:creatinine 3–30mg/mmol and GFR <60mL/min, Evidence of light chain proteinuria, Consider renal biopsy.After confirm diagnosis of MGRS by: Light microscopy. Immunofluorescence staining for IgG subclasses, IgA and IgM, and kappa and lambda Note: M protein detected in serum and/or urine must match the one found in the renal biopsy. Electron microscopy. PET/CT, low-dose CT, or whole-body MRI as clinically indicated. Bone marrow biopsy if suspected to have MM or WM. Do additional workup as clinically indicated. After, for treatment is MGRS lgG, lgA, or FLC MGRS?
--------If Yes, perform myeloma therapy, Is the patient a transplant candidate?
----------If Yes, Is the patient frail?
------------If No (frail score <2), Does the patient have either renal insufficiency or peripheral neuropathy?
--------------If No, Is the patient standard or high risk?
----------------If Standard risk, The treatments for the patient are Bortezomib/Lenalidomide/Dexamethasone combination or Carfilzomib/Lenalidomide/Dexamethasone or Carfilzomib/Lenalidomide/Bortezomib/Dexamethasone or Ixazomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------------If High Risk, The treatments for the patient are Daratumumab/Carfilzomib/Lenalidomide/Dexamethasone or Daratumumab/Cyclophosphamide/Bortezomib/Dexamethasone or Daratumumab/Bortezomib/Thalidomide/Dexamethasone or VTD-PACE. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If Yes, Does the patient have acute renal insufficiency or have chronic renal insufficiency and/or peripheral neuropathy?
----------------If Chronic Renal insufficiency and/or Peripheral Neuropathy, The treatments for the patient are Carfilzomib/Cyclophosphamide/Dexamethasone or Ixazomib/Cyclophosphamide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------------If Acute Renal Insufficiency, The initial treatment for the patient is Bortezomib/Cyclophosphamide/Dexamethasone. After improvement of the renal function, the treatment for the patient is Bortezomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
------------If Yes (frail score >=2), The treatments for the patient are Bortezomib/Dexamethasone or Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
--------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
--------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
----------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
----------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
--------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
--------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------If No, Is the patient frail?
------------If Yes (frail score >=2), The treatments for the patient are Bortezomib/Dexamethasone or Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
--------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
--------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
----------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
----------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
--------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
--------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
--------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
----------------------If No, Patient is treated.
----------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
------------If No (frail score <2), Does the patient have either renal insufficiency or peripheral neuropathy?
--------------If No, The treatments for the patient are Bortezomib/Lenalidomide/Dexamethasone or Daratumumab/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
----------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
----------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
--------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
----------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
--------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
----------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
----------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
------------------------If No, Patient is treated.
------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------------If Yes, Does the patient have acute renal insufficiency or have chronic renal insufficiency and/or peripheral neuropathy?
----------------If Chronic Renal insufficiency and/or Peripheral Neuropathy, The treatments for the patient are Carfilzomib/Cyclophosphamide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
----------------If Acute Renal Insufficiency, The initial treatment for the patient is Bortezomib/Cyclophosphamide/Dexamethasone. After improvement of the renal function, the treatment for the patient is Bortezomib/Lenalidomide/Dexamethasone. With Myeloma therapy done, Perform follow-up/surveillance as follows: [(Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential, platelet count, blood glucose and electrolytes, and metabolic panel),(Serum quantitative immunoglobulins, SPEP, and SIFE),(24-h urine for total protein, UPEP, and UIFE at baseline and as clinically indicated or if there is a significant change in FLC levels),(Serum FLC assay),(Whole-body imaging with MRI without contrast, low-dose CT scan, FDG PET/CT annually or as clinically indicated, ideally with the same technique used at diagnosis),(Bone marrow aspirate and biopsy at relapse with FISH as clinically indicated),(Assess for hematopoietic cell transplant candidacy: Refer for evaluation at a hematopoietic cell transplant center. Harvest hematopoietic stem cells (consider for 2 transplants if appropriate),(Consider minimal residual disease (MRD) as indicated for prognostication after shared decision with patient),(See NCCN Guidelines for Survivorship)] After completetion of follow-up/surveillance, analyze for response. Was there a response?
------------------If No, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care.
------------------If Yes, Regardless of transplant or therapy perform follow-up/surveillance by: • Laboratory assessments appropriate for monitoring treatment toxicities may include: CBC, differential,
platelet count, blood glucose and electrolytes, and metabolic panel. • Serum quantitative immunoglobulins, SPEP, and SIFE. • 24-h urine for total protein, UPEP, and UIFE at baseline
and as needed or if there is a significant change in FLC levels. • Serum FLC assay. • Whole-body advanced imaging with FDG PET/CT, low-dose CT scan, MRI without contrast as needed, ideally with the same technique used at diagnosis. • Bone marrow aspirate and biopsy with multi-parameter flow cytometry as needed. • Consider MRD as indicated for prognostication aftershared decision with patient. Afterwards, is treatment needed for post-transplant or for relapsed/progressive diseases after continuous/maintenance myeloma therapy without prior transplant?
--------------------If For Relapsed/progressive diseases without prior transplant, after continuous/maintenance myeloma therapy, Perform therapy for previously treated myeloma or consider a clinical trial. With refractory disease and lack of treatment options, refer to palliative care. 
--------------------If For post-transplant, Is it for a Post-autologous hematopoietic cell transplant (single or tandem) or Post-allogeneic hematopoietic cell transplant?
----------------------If Post-autologous hematopoietic cell transplant (single or tandem), is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial or through Allogeneic hematopoietic cell transplant.
------------------------If Response/Stable disease, Perform maintenance therapy (category 1) or a clinical trial. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through clinical trial +/- additional autologous hematopoietic cell transplant or through Allogeneic hematopoietic cell transplant.
----------------------If Post-allogeneic hematopoietic cell transplant, is it a Progressive disease or a Response/Stable disease?
------------------------If Progressive disease, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial or through Donor lymphocyte infusion.
------------------------If Response/Stable disease, Perform maintenance therapy on clinical trial or observe. Is the disease now progressive?
--------------------------If No, Patient is treated.
--------------------------If Yes, Perform additional treatment by therapy for previously treated myeloma, or through a clinical trial through Donor lymphocyte infusion.
--------If No, Is MGRS lgM MGRS or MGRS with monoclonal B-cell lymphocytosis (MBL) features?
----------If lgM MGRS, follow NCCN Guidlines for Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphomaa. After, use response criteria for WM. Then measure relapse and individualize treatment based on response and toxicity of prior therapy, patient’s performance status, and renal function at the time of relapse.
----------If MGRS with monoclonal B-cell lymphocytosis (MBL) features, follow NCCN Guidelines for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Then, evaluate renal function and bone marrow involvement or radiologic findings. After, measure relapse and individualize treatment based on response and toxicity of prior therapy, patient’s performance status, and renal function at the time of relapse.
----If MGNS, rule out other causes of neuropathy: Diabetes, Cobalamin deficiency, Thyroid dysfunction, Lyme disease, HIV infection, Syphilis, Autoimmune disease, Cryoglobulinemia, Evaluation for light chain amyloidosis, Anti-MAG antibodiesa, Ganglioside antibody panel, Nerve conduction study (NCS)/electromyogram (EMG), Neurology consult, MYD88 L265P allele-specific PCR (AS-PCR) testing of bone marrow, Chest/abdominal/pelvic CT with contrast
when possible. After are clinical flindings high suspicion or low suspicion?
------If High Suspicion, findings must have or be Sensory predominant, Length dependent, Slow progression (years), Bilateral and symmetrical, Antibodies present, Demyelination by EMG/NCS
OR intermediate suspicion (not high or low suspicion) AND affecting activities of daily living (ADLs). After observation should be done and NCCN Guidlines for Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphomaa should be followed.
------If Low Suspicion, findings must have or be Motor/pain predominant, Non-length dependent, Rapid progression (weeks to months), Unilateral/asymmetrical, Antibodies not present, No Demyelination by EMG/NCS OR intermediate/high suspicion AND not affecting ADLs. After observation should be done and NCCN Guidlines for Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphomaa should be followed.