Consensus-based recommendations by the Hematology Society of Taiwan for the management of multiple myeloma in 2026.

Abstract

Multiple myeloma (MM) presents a growing challenge in Taiwan's aging population, necessitating practical treatment strategies that integrate clinical evidence with real-world constraints. The 2026 Practice Guidelines from the Hematology Society of Taiwan offer a consensus-based framework tailored to Taiwan's healthcare system, balancing efficacy, accessibility, and reimbursement limitations. Given the scarcity of international clinical trials addressing "fixed-duration" therapy mandated by reimbursement-driven treatment cessation, these guidelines utilize a deliberative consensus process to bridge the evidence vacuum between global standards and local regulatory realities. The framework specifically addresses NHI-imposed administrative limits, while providing strategic recommendations for managing symptomatic relapse-a prerequisite for next-line therapy access. These guidelines outline diagnostic standards based on the IMWG criteria and risk stratification, offering alternative monitoring approaches when serial FISH, PET-CT, or MRD testing is unavailable. They emphasize individualized treatment, considering autologous stem cell transplantation eligibility, frailty scoring, and comorbidities. Proteasome inhibitors, immunomodulatory drugs, and monoclonal/bispecific antibodies are recommended across induction, consolidation, and relapsed/refractory settings, with specific dose adjustments for special populations. This document serves as a vital reference for oncology providers in Taiwan and regions facing similar "reimbursement cliffs," balancing high-level evidence with practical resource management.