Malaysian Expert Consensus Guidelines for the Diagnosis and Management of Multiple Myeloma: A Modified Delphi Approach

The rising incidence of multiple myeloma (MM) in Malaysia, combined with limited access to newer therapies, highlights the need for locally adapted clinical guidance. This consensus aimed at establishing expert recommendations for the management of MM within Malaysia's resource-variable healthcare system. A modified Delphi process was conducted with 11 haematologists. To inform evidence-based recommendations, a targeted literature review was performed from January 2012 to June 2025. These recommendations were then evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. A total of 58 consensus statements were developed across various areas, including diagnosis, staging, treatment of newly diagnosed and relapsed/refractory disease, renal impairment, infection prevention, high-risk smouldering myeloma, and supportive care. Agreement was assessed using a three-point Likert scale, with all statements achieving ≥ 80% consensus. Consensus recommendations highlighted that triplet induction remains the minimum standard for transplant-eligible patients in Malaysia. Quadruplet regimens deliver deeper responses and improved survival but are limited by regulatory and cost barriers across Asian health systems. In transplant-ineligible patients, treatment should be individualised based on age, frailty, cytogenetic risk, comorbidities, and financial considerations. Novel cellular and immune-based therapies, including CAR-T cells and bispecific antibodies, offer meaningful benefit in heavily pretreated disease, though availability remains restricted. Infection prophylaxis, immunoglobulin support, vaccination, and proactive management of myeloma-related bone disease are essential components of comprehensive care. Continued efforts to improve access to advanced diagnostics, novel therapies, and clinical trial participation will be critical to further enhance outcomes. This consensus provides a standardised, evidence-based framework to optimise MM care and improve patient outcomes nationally.