Today, we are comparing multiple myeloma clinical practice guidelines from the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario (CCO) and the National Comprehensive Cancer Network (NCCN). For this side-by-side comparison, we took a focused look at smoldering multiple myeloma.
Both guidelines were published in January 2026. The ASCO/OH-CCO guideline addresses whether smoldering myeloma should be treated, and if so, the criteria and treatment regimens to consider. The NCCN guideline also provides a recommendation on treatment, while also addressing surveillance and follow-up testing for individuals with smoldering multiple myeloma.
| Item | Treatment of Multiple Myeloma | Multiple Myeloma |
|---|---|---|
| Authoring Organization | American Society of Clinical Oncology (ASCO) and Cancer Care Ontario (CCO) | National Comprehensive Cancer Network (NCCN) |
| Publication Date | January 2026 | January 2026 |
| Links | Summary / Full Text | Full Text |
Key Takeaways
Both guidelines support treatment in carefully selected patients.
ASCO suggests daratumumab or active monitoring as their treatment options, while NCCN includes daratumumab or lenalidomide. ASCO does not routinely recommend lenalidomide.
Below, you can view a direct comparison of the recommendations provided from the ASCO/OH-CCO and NCCN guidelines regarding smoldering multiple myeloma.
Comparison of Recommendations
| Item | ASCO/CCO | NCCN |
|---|---|---|
| Treatment | Patients with high-risk smoldering multiple myeloma may be offered active monitoring or daratumumab (for up to 36 months). Lenalidomide is not routinely recommended. Therapy for patients with smoldering multiple myeloma who are not at high risk is not recommended. | The guideline recommends treatment with daratumumab or lenalidomide. Patients considered for systemic therapy intervention should be carefully selected through a shared decision making process. |
| Surveillance/Follow Up Tests | Not addressed. | The guideline recommends that follow-up assessments use the same imaging modality from the initial assessment. |
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