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keeping track of the myeloma: monitoring


Confirmation of Response

How much did the monoclonal protein change since the last measurement or treatment?  The HevyLite test provides a new blood (serum) test to accurately measure response at a very low level. It is a more sensitive and precise test for low level monitoring versus the IFE test: especially for IgA myeloma.

The goal is to achieve at least a 50% drop or reduction in the monoclonal/M-SPIKE level. This is a partial response (PR). The various higher levels of response such as VGPR, CR or sCR are reviewed in STEP 6.

With typical novel combination therapies currently used the initial response tends to be quite rapid. Within 2-3 months, major response will or should have occurred. If it does, treatment may be adjusted to improve tolerance for the longer term. If not, back up strategies/plans will be discussed. 

Watching out for Side Effects/ Toxicities

It is crucial for the patient to inform the doctor and/or nurses or other caregivers about side effects. Dose adjustments can be made promptly so that side effects will be reversible rather than become ongoing, chronic or worsening. This is especially true for any type of nerve damage or neuropathy indicated by loss of sensation, pain, or any other concerns with nerve function. At all times one must balance the need to get the myeloma into remission and the possibility of side effects.

Follow-up Testing

In general, basic testing, including blood counts, chemistry panel, M-SPIKE measurements, Freelite testing and possibly 24-hour urine (if patient has light chain ONLY or BJ disease) is done with each cycle, i.e. every 3-4 wks for the first 4 cycles. X-rays or scans are only repeated after several months unless there are new concerns. Bone marrow tests typically are repeated only to confirm if a complete response (CR) has been achieved. If progression or possible relapse is a concern, then follow up bone marrow may be required.


Click to view the slides for this step.


©2015 International Myeloma Foundation

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