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SEER Inquiry System - Report
Produced: 10/29/2026 4:50 PM
Question 20260021
Inquiry Details
References:
Heme & Lymph Manual & DB. October 2025 update
Question:
First Course Treatment/Heme & Lymphoid Neoplasms--Multiple Myeloma: Is treatment for multiple myeloma coded as first-course treatment until patient achieves remission despite the possibility of progression due to a delay in treatment? A patient with multiple myeloma was advised treatment with Dara-RVD followed by a stem cell transplant. As the patient wanted to take care of another health issue, the patient waited 8 months to start treatment.
Discussion:
Answer:
Code treatment as first course of treatment, even though there was an 8-month delay. The patient's treatment plan was to delay the cancer treatment due to another health condition. When that health condition was resolved, then the cancer treatment was given. Patients do delay treatment for many different reasons, but most of them would not be 8 months. This fits the new rule which is all treatment is first course until remission.
This is different from active surveillance, where the patient is being monitored for symptoms/disease progression. We have a clarification coming out in the 2027 updates that states if Active Surveillance is the planned treatment until symptoms appear, that any treatment received after active surveillance is second course. That is not the situation here. This is delayed therapy.
