This protocol addresses patients with multiple myeloma who develop myeloma-associated anaemia with haemoglobin below 10 g/dl, once other causes of anaemia have been systematically excluded.
The patient has multiple myeloma with confirmed myeloma-associated anaemia. Haemoglobin is below 10 g/dl and a clinical workup has excluded alternative aetiologies before this approach is initiated.
The approach centres on erythropoiesis-stimulating therapy to correct the anaemia, with the goal of maintaining haemoglobin within a defined safe upper limit. Additional haematopoietic support may be needed in the context of chemotherapy-related cytopenias. The complete structured regimen is available in the full protocol.
Recombinant human erythropoietin and darbepoetin alfa can be used for the treatment of myeloma-associated anaemia (haemoglobin levels <10 g/dl) if other causes of anaemia have been excluded.
The target is to maintain haemoglobin levels <12 g/dl to avoid thromboembolic complications and hypertension [II, B].
Treatment with granulocyte colony-stimulating factor might be required to treat chemotherapy-induced severe neutropenia [II, B].
DOI: 10.1038/s41571-025-01041-x
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