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Review
. 2025 Sep;22(9):680-700.
doi: 10.1038/s41571-025-01041-x. Epub 2025 Jul 7.

EHA-EMN Evidence-Based Guidelines for diagnosis, treatment and follow-up of patients with multiple myeloma

Meletios A Dimopoulos #  1 , Evangelos Terpos #  2 , Mario Boccadoro  3 , Philippe Moreau  4 , María-Victoria Mateos  5 , Sonja Zweegman  6 , Gordon Cook  7   8 , Monika Engelhardt  9 , Michel Delforge  10 , Roman Hajek  11   12 , Fredrik Schjesvold  13 , Francesca Gay  14 , Salomon Manier  15   16 , Katja C Weisel  17 , Martin Kaiser  18   19 , Niels W C J van de Donk  6 , Elena Zamagni  20   21 , Paula Rodriguez-Otero  22 , Aurore Perrot  23 , Christoph Driessen  24 , Jelena Bila  25 , Edward Laane  26 , Dominik Dytfeld  27 , Cyrille Touzeau  4 , Meral Beksac  28 , Marc S Raab  29 , Michele Cavo  21 , Mohamad Mohty  30   31 , Andrew Spencer  32   33 , Heinz Ludwig  34 , Hermann Einsele  35 , Jesus San-Miguel  22 , Pieter Sonneveld  36
Affiliations
Review

EHA-EMN Evidence-Based Guidelines for diagnosis, treatment and follow-up of patients with multiple myeloma

Meletios A Dimopoulos et al. Nat Rev Clin Oncol. 2025 Sep.

Abstract

Since the publication in 2021 of the European Hematology Association (EHA) Clinical Practice Guidelines for the treatment of patients with smouldering multiple myeloma (SMM) and multiple myeloma (MM), developed in collaboration with the European Society for Medical Oncology, a novel international staging system (R2-ISS) has been developed, several prognostic factors are entering clinical practice (such as minimal residual disease, circulating plasma cells and monoclonal protein assessed by mass spectrometry) and, at the time of writing, 14 novel regimens have been approved by the EMA and/or the FDA for the treatment of patients with MM. A multidisciplinary group of experts from the EHA and European Myeloma Network, based in various institutions mostly located in Europe, have updated the previous guidelines and produced algorithms for everyday clinical practice that incorporate levels of evidence and grades of recommendation based on the aforementioned new data. In these Evidence-Based Guidelines, we provide key treatment recommendations for both patients with newly diagnosed MM and those with relapsed and/or refractory MM, including guidance for the use of established drugs as well as contemporary immunotherapies. Novel approaches for the management of patients with SMM focus on those who might require early intervention. Finally, we provide recommendations for myeloma-related complications and adverse events, such as bone disease, renal impairment and infections, as well as for those associated with T cell-mobilizing therapies, such as cytokine-release syndrome and immune effector cell-associated neurotoxicity syndrome.

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Conflict of interest statement

Competing interests: M.A.D. has received honoraria as a consultant, or member of the advisory board or speaker’s bureau for Amgen, AstraZeneca, Beigene, BMS, GSK, Janssen, Menarini, Regeneron, Sanofi, Swixx and Takeda. E.T. has been a member of the advisory board for Amgen, AstraZeneca, BMS, EUSA Pharma, GSK, Johnson & Johnson, Menarini, Pfizer, Sanofi and Takeda; has received honoraria from Amgen, Antengene, AstraZeneca, BMS, EUSA Pharma, Forus, GSK, Johnson & Johnson, Menarini, Novartis, Pfizer, Sanofi, Swixx and Takeda; research funding from Amgen, GSK, Johnson & Johnson, Sanofi and Takeda; and travel expenses from Takeda. M.Bo. has received honoraria from AbbVie, Amgen, BMS, Celgene, Janssen, Novartis and Sanofi; has been a member of the advisory board for GSK and Janssen; and has received research funding from Amgen, BMS, Celgene, Janssen, Mundipharma, Novartis and Sanofi. P.M. has received honoraria as a member of the advisory board for Abbvie, Amgen, BMS, Johnson & Johnson, Pfizer, Sanofi and Takeda. M.-V.M. has received honoraria as a member of the advisory board for Abbvie, Amgen, BMS, GSK, Johnson & Johnson, Kite, Menarini, Oncopeptides, Pfizer, Roche and Sanofi. S.Z. has received research support from Janssen and Takeda; and has been a member of the advisory board for BMS, Janssen, Sanofi and Oncopeptides, for which she received no personal funding. G.C. has received research funding from BMS, Johnson & Johnson and Takeda, BMS; acted as a paid consultant for AstraZeneca, Johnson & Johnson, Menarini and Pfizer; and acted as a member of the speaker’s bureau for Johnson & Johnson, Menarini and Pfizer. M.E. has been a member of the advisory board for BMS, GSK, Janssen, Menarini, Oncopeptides, Pfizer, Sanofi; and received honoraria from Abbvie, BMS, GSK, Janssen, Menarini, Oncopeptides, Pfizer and Sanofi. M.D. has received honoraria as a member of the advisory board or speaker’s bureau for AbbVie, Amgen, BMS, GSK, Johnson & Johnson, Menarini, Pfizer, Roche and Sanofi; and works for an institution that receives grants from Johnson & Johnson. R.H. has been a consultant or member of the advisory board for Abbvie, Amgen, BMS, Celgene, Janssen, Novartis, PharmaMar and Takeda; has received honoraria from Amgen, BMS, Celgene, Janssen, PharmaMar and Takeda; and has received research funding from Amgen, BMS, Celgene, Janssen, Novartis and Takeda. F.S. has been a consultant for AbbVie, BMS, Celgene, GSK, Johnson & Johnson, Oncopeptides, Sanofi and Takeda; has received honoraria from AbbVie, Amgen, BMS, Celgene, Daiichi–Sankyo, GSK, Johnson & Johnson, Novartis, Oncopeptides, Sanofi, Schain, SkylineDx, Skylite and Takeda; and has received research funding from Celgene, GSK, Johnson & Johnson, Oncopeptides, Sanofi and Targovax. F.G. has been a member of the advisory board for Abbvie, Amgen, AstraZeneca, BMS, Celgene, GSK, Janssen, Kite, Pfizer, Regeneron, Roche Pharma, Sanofi and Takeda; and has received honoraria from Abbvie, BMS, Celgene, Janssen, Menarini, Pfizer, Regeneron, Roche, Sanofi and Takeda. S.M. has been a consultant for Abbvie, Adaptive Biotechnology, Amgen, BMS, Celgene, GSK, Janssen, Kite, Novartis, Pfizer, Regeneron, Roche, Sanofi and Takeda. K.C.W. has had an advisory role or provided expert testimony for Abbvie, Adaptive, Amgen, AstraZeneca, Beigene, BMS, Celgene, GSK, Janssen, Karyopharm, Menarini, Oncopeptides, Pfizer, Regeneron, Roche, Sanofi and Takeda; has received honoraria from Abbvie, Adaptive, Amgen, AstraZeneca, Beigene, BMS, Celgene, GSK, Janssen, Karyopharm, Menarini, Novartis, Oncopeptides, Pfizer, Regeneron, Roche, Sanofi and Takeda; and has received research funding from Abbvie, Amgen, BMS, Celgene, GSK, Janssen and Sanofi. M.K. has had an advisory role or provided expert testimony for Abbvie, Adaptive, BMS, Celgene, GSK, Janssen, Pfizer, Regeneron, Roche, Sanofi and Takeda; and works for an institution that has received research support from BMS, Celgene and Janssen. N.W.C.J.v.d.D. has received research support from Amgen, BMS, Celgene, Cellectis, Janssen and Novartis; and has been a member of the advisory board for AbbVie, Adaptive, Amgen, Bayer, BMS, Celgene, Janssen, Kite, Merck, Novartis, Pfizer, Roche, Sanofi, Servier and Takeda; all these roles have been paid to his institution. E.Z. has received honoraria as a member of the advisory board for Amgen, BMS, GSK, Janssen, Menarini, Pfizer, Oncopeptides and Sanofi. P.R.-O. has received honoraria as a member of the advisory board participation or as a consultant for Abbvie, AstraZeneca, BMS, GSK, H3Biomedicine, Johnson & Johnson, Pfizer, Regeneron, Roche and Sanofi; has been a member of the speaker’s bureau for Abbvie, BMS, GSK, Johnson & Johnson, Pfizer and Sanofi; and has received travel grants from Pfizer. A.P. has received honoraria as a member of the advisory board for Abbvie, Amgen, BMS, GSK, Johnson & Johnson, Menarini, Pfizer and Sanofi. C.D. has received honoraria for advisory roles for Amgen, BMS, GSK, Janssen, Pfizer and Sanofi. J.B. has had an advisory role or provided expert testimony for Amgen, Amicus, Galenika, Johnson & Johnson, Pfizer and Takeda; and has received honoraria from Amgen, Amicus, Galenika, Hemofarm, Johnson & Johnson, Pfizer and Takeda. D.D. has received honoraria from Amgen, BMS, GSK, Janssen, Pfizer and Sanofi; and research funding from Amgen, Celgene and Janssen. C.T. has received honoraria from Abbvie, Amgen, BMS, GSK, Janssen, Pfizer and Sanofi; and research support from Abbvie, GSK, Sanofi and Takeda. M.Be. has been a member of the advisory board for BMS, GSK, Janssen, Menarini, Pfizer, Sanofi and Takeda; a member of the speaker’s bureau for BMS, GSK, Menarini, Pfizer, Sanofi and Takeda; and has received research support from Janssen. M.S.R. has had an advisory role for Abbvie, BMS, GSK, Janssen, Karyopharm, Menarini, Oncopeptides, Pfizer and Sanofi; has received honoraria from Abbvie, BMS, GSK, Janssen, Karyopharm, Menarini, Novartis, Oncopeptides, Pfizer and Sanofi; and has received research funding from BMS, Celgene, Janssen and Sanofi. M.C. has been a consultant or had an advisory role for AbbVie, Amgen, BMS, Celgene, GSK, Janssen, Karyopharm, Menarini and Sanofi; and has received honoraria from Amgen, AbbVie, BMS, Celgene, GSK, Karyopharm, Janssen, Menarini and Sanofi. M.M. has been a consultant or had an advisory role for Janssen, Jazz and Sanofi; has received grants or research support from Janssen and Sanofi; has been a member of the speaker’s bureau for Janssen, Jazz and Sanofi; and has received honoraria from Amgen, Janssen, Novartis, Pfizer, Sanofi and Takeda. A.S. has been a consultant for BMS, Celltrion, Haemalogix, Janssen and Rheumagen; a member of the speaker’s bureau for BMS, Janssen, Pfizer, Sanofi and Thermofisher; a member of the advisory board for Antengene, BMS, Roche, Haemalogix, Janssen, Pfizer and Sanofi; received honoraria from AbbVie, Antengene, BMS, Roche, Haemalogix, Janssen, Pfizer, Sanofi and Thermofisher; and received research funding from AbbVie, Antengene, Haemalogix and Janssen. H.L. has been a consultant or a member of the speaker’s bureau for Amgen, BMS, Celgene, Janssen, Pfizer, Sanofi and Takeda; and received research funding from Amgen and Sanofi. H.E. has been a consultant or had advisory roles for Amgen, BMS, Celgene, GSK, Janssen, Novartis, Sanofi and Takeda; has received research funding from Amgen, BMS, Celgene, GSK, Janssen and Sanofi; and honoraria and travel support from Amgen, BMS, Celgene, GSK, Janssen, Novartis, Sanofi and Takeda. J.S.-M. has been a consultant for Abbvie, Amgen, BMS, Celgene, Roche, GSK, HaemaLogiX, Janssen, KaryoPharm, Merck, Novartis, Pfizer, Regeneron, Sanofi, SecuraBio and Takeda. P.S. has been a consultant or had advisory roles for BMS, Celgene, GSK, Janssen and Sanofi; has received research funding from Amgen, BMS, Celgene, Janssen, Karyopharm and Sanofi; and honoraria from BMS, Celgene, GSK, Janssen and Sanofi. E.L. declares no competing interests.

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