Interpretation of 2026 update of Clinical Practice Guidelines in Oncology： Multiple Myeloma （Version 3） of National Comprehensive Cancer Network

doi:10.16150/j.1671-2870.2026.01.005

Abstract

Abstract:

The disease burden of multiple myeloma (MM) has been continuously increasing globally and in China. In 2021, the number of newly-diagnosed MM cases globally reached 148 754.63, and the number of deaths was 116 359.63. In China, the number of newly-diagnosed cases was 17 250, and the number of deaths was 12 984. The burden is heavier in males, elderly populations, and economically developed regions, while the rising prevalence in younger populations also deserves attention. The disease burden of MM is expected to continue to increase in the future, with high body mass index being an important associated risk factor. In 2025, the "Clinical Practice Guidelines in Oncology: Multiple Myeloma" issued by the National Comprehensive Cancer Network (NCCN) underwent rapid iterations from Version 1.2026 (hereafter referred to as 2026.V1) to Version 3.2026 (2026.V3), covering the entire process of MM diagnosis and treatment. This study compares and interprets the 2026.V1 guideline with the 2025.V2 version, and supplements the interpretation of updates in 2026.V2 and 2026.V3, aiming to help clinicians improve MM diagnosis and treatment, optimize the management of high-risk MM patients, and further enhance the prognosis of MM patients in China. The core content of this study can be summarized as "three additions, four optimizations, two focuses, and one emphasis". The "three additions" include the incorporation of individualized treatment for special populations, diagnostic and therapeutic pathways for MM with central nervous system (CNS) involvement, and management of monoclonal immunoglobulin deposition disease (MIDD). The "four optimizations" include strengthening the application of next-generation sequencing (NGS) and renal biopsy in diagnostic examination, incorporating International Myeloma Society/International Myeloma Working Group (IMS-IMWG) criteria in high-risk stratification for precise identification of high-risk patients, emphasizing four-drug combination priority for newly diagnosed patients and earlier use of immunotherapy for relapsed patients in treatment regimens, and clarifying the timing of PET/CT application in follow-up monitoring. The "two focuses" refer to focusing on infection prevention (refining infection control for treatments such as chimeric antigen receptor T cell therapy [CAR-T]) and renal function protection (clarif-ying preferred drugs and doses of bone-modifying agents). The "one emphasis" refers to giving attention to the management of solitary plasmacytoma and smoldering myeloma subtypes. The 2026.V1 guideline focuses on "precision, diversity, and whole-course management", highlighting multidisciplinary collaboration and individualized treatment, while the 2026.V2 and 2026.V3 further optimize drug recommendations for relapsed/refractory patients.

Key words: Multiple myeloma, Guideline interpretation, High-risk factors, Immunotherapy

CLC Number:

R446
R733.3

TAO Yi, MI Jianqing. Interpretation of 2026 update of Clinical Practice Guidelines in Oncology： Multiple Myeloma （Version 3） of National Comprehensive Cancer Network[J]. Journal of Diagnostics Concepts & Practice, 2026, 25(01): 30-36.

Figures/Tables 2

Table 1

Table 2

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对比维度	2025.V2 版指南（旧版）	2026.V1版指南（新版）
新增核心章节	-	新增“特殊人群治疗”章节；新增“MM伴CNS病变”专项诊疗路径；新增“MIDD”管理章节
优化诊断检查	未强制要求NGS检测TP53突变；无明确肾活检指征；	明确NGS检测TP53突变作为初始诊断必做项目；明确“白蛋白尿或肾功能异常时需行肾活检”；
优化危险分层	未纳入IMS-IMWG分层体系；高危定义未明确多种因素组合要求；	纳入IMS-IMWG风险分层标准，优化高危定义，需≥2个传统高危因素才界定为高危（原双打击MM）
优化治疗方案	初诊患者以三药联合为主；复发患者免疫治疗推荐靠后；	初诊患者四药联合优先、复发患者免疫治疗前移
优化随访监测	孤立性浆细胞瘤随访无明确影像评估频次；未明确PET/CT应用节点	软组织/头颈部病变初始3个月后可按需降低频次；明确自体造血干细胞移植后100 d推荐行全身PET/CT；
聚焦支持治疗	感染防控无CAR-T/BsAb专项推荐；肾功能保护无明确骨改良药物剂量调整	明确CAR-T/BsAb治疗相关感染防控细节；明确硼替佐米/达雷妥尤单抗为肾功能不全患者首选，明确唑来膦酸肾损伤患者剂量
重视亚型管理	对孤立性浆细胞瘤、冒烟型骨髓瘤无细化分层管理	孤立性浆细胞瘤细分“伴微小骨髓受累”亚型；冒烟型骨髓瘤按“低危/高危”分层管理，高危人群强化监测与早期干预

风险分层	核心定义
标准风险	未满足高危分层标准的所有患者
高危	满足以下任一条件。 1. del (17p)（浆细胞中占比>20%）和（或）TP53基因突变； 2. t(4;14)、t(14;16)、t(14;20)易位之一合并1q+和（或）del(1p32)； 3. 单等位基因del(1p32)合并1q+，或双等位基因del(1p32)； 4. 高血β₂微球蛋白（>5.5 mg/dL）且血肌酐正常（<1.2 mg/dL）（1 L=10 dL）