Module 1: Screening, Diagnosis, and Staging of Multiple Myeloma
Section 5: Monitoring Patients
Understandably, physicians disagree about how quickly and how aggressively to begin treatment. How do you monitor patients?
Dr. Robert Kyle: Patients who have asymptomatic multiple myeloma need to be followed closely. If the M-spike is high and the hemoglobin is at borderline levels, the physician should recheck the laboratory studies in 2 months. This would include a repeat of the serum protein electrophoresis and a CBC as well as calcium and creatinine levels. If the patient has a monoclonal light chain in the urine, a 24-hour urine specimen should also be collected and then examined for the amount of light chain in the urine. If the situation is such that the M-protein and other indicators are not too high, one can reevaluate the patient at 3 to 6 months. However, this is a very variable sort of situation and requires the clinical judgment of the physician in deciding exactly when to reevaluate the patient.
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Dr. Robert Kyle: When following patients with asymptomatic multiple myeloma, I think that a metastatic bone survey should be repeated at 6-month intervals. These patients can develop lytic lesions that do not produce pain. If lytic lesions do occur, one must seriously consider instituting systemic therapy.
Dr. Brian Durie: An important element of monitoring patients who may be at risk for developing multiple myeloma is to not rely upon a single test but to regularly monitor a series of tests that would allow evaluation of bones, renal function, bone marrow function, and other organ functions. For example, if the myeloma protein level is increasing, this is not sufficient in itself to justify systemic therapy. Likewise, if the serum beta2-microglobulin has increased, this is not necessarily a sufficient reason to jump in with systemic therapy. Another benefit of monitoring multiple tests is that it avoids missing problems that could eventually present as an emergency.
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