How To Deal With Relapse?
July 26, 2008
Boston, Massachusetts
Brian G.M. Durie, M.D.

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What is Relapse?
Regrowth of myeloma
Increase in M-protein in blood/urine
"Biochemical Relapse"
New CRAB ft
features
"Clinical Relapse"
p

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Understanding Relapse
Can be
be single
single lesion
lesion or
or multiple
multiple sites:
sites: in
in
bone/out of bone
On/Off treatment different
different
Important to consider:
Pi
Prior response( )
s
Length of response(s)
Number of prior treatments
B2M, FISH, LDH, ...

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Monitoring Issues
M-
M protein Blood/Urine
Blood/Urine
Serum Free Light Chain (FLC)
MRI / PET/CT
FISH / Chromosome Testiting
Bone Marrow
Marrow

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Supportive Care Issues
Infection
Blood Clots
Neuropathy
Kidneys
Bones
Other Medical
Medical Problems
Costs / Reimbursement

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Relapse Treatment
Can produce
produce long benefit not
not just a
"stop-gap"
New agents can mean better
remissions
Plan for multiple sequential
treatments

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Treatment Options
Thalidomide/Velcade/Revlimid/Doxil
Review transplant possibilities
Don'tf
Don't orgeto
forget ld
old drugs
drugs
Cytoxan/Melphalan
d
Adriamycin
Etoposide/Platinum...
Be aware of new drug trials

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Relapse is
is the
the Next Step
in Your Ongoing Care
Care
Time is Yo
Your
ur Friend

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