What is Relapse?
There are 2 types of relapse
- “Biochemical” or “M-SPIKE ONLY” Relapse
- In this case, there has been a 25% increase (from the low point or best response level) in the M-SPIKE in the blood and/or urine. This is the technical definition of relapse used in clinical trials. The M-SPIKE must increase by at least 500mg/dl in the serum and/or 200mg/24hrs in the urine.
- Clinical Relapse
- In this case, new myeloma has emerged, which is producing or starting to produce medical problems for the patient. The same “CRAB” criteria are used just as at the start of initial treatment. This is when new treatment is required or the current regimen needs to be enhanced in some way (increased dosage or adding in steroids [Dexamethasone or Prednisone] or including a new drug).
Testing at Relapse
- It is obviously very important to know if relapse is occurring.
- If there is a sudden change in the M-SPIKE (unexpected) the first thing to do is to REPEAT THE TEST. Make sure it is correct and not some kind of mix up or lab error.
- If the patient experiences a sudden change, such as acute pain, swelling, fever, or anything else unusual or unexpected this should be checked out as soon as possible. Call your doctor and/or the office or clinic right away and most likely they will have you go in for a checkup.
- Specific testing required varies considerably depending upon the exact circumstances
- Typically, a full set of lab tests will be redone as in the past
- X-rays or scans may be needed
- You may need to have a follow up bone marrow test. If so, genetic testing with FISH and/or cytogenetics will often be done to assess or re-assess the risk status
- Kidney, heart, lung, or other testing may be needed. Biopsy may also be needed.
Options at Relapse
- The options and approaches at relapse have been extensively reviewed with many articles published.
Click to view the slides for this step.
ASH 2011 presentations that address STEP 9
©2011 International Myeloma Foundation