Do you need a change in treatment?
It’s important to assess possible relapse very carefully. One lab test on its own could be flawed, so it’s important to double-check. The continued presence of CRAB features will in part determine if new treatment is needed. If new treatment IS needed can a prior successful therapy work again? Discuss the options with your doctor.
What is Relapse?
There are 2 types of relapse
- “Biochemical” or “M-SPIKE ONLY” Relapse
- In “Biochemical” or “M-SPIKE ONLY” there will have 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 Clinical Relapse, 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 such as Dexamethasone or Prednisone or 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. The specific testing required varies considerably depending upon the exact circumstances. Typically, a full set of lab tests will be redone as in the past.
(See “The Myeloma Patient's Guide to Understanding Your Test Results” )
X-rays or scans may be needed, or you may need to have a follow up bone marrow test. 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 including biopsy may also be needed.
Options at Relapse
New drug combinations have been highly effective, particularly at dealing with myeloma clones that can emerge to hinder patient progress. An excellent IMF video from the 2014 Annual Meeting of the American Hematology Society explains options for treatment following relapse.
- The options and approaches at relapse have been extensively reviewed with many articles published.
Click to view the slides for this step.
©2015 International Myeloma Foundation