Evaluating response to treatment of multiple myeloma
- S Vincent Rajkumar, MD
S Vincent Rajkumar, MD
- Edward W. and Betty Knight Scripps Professor of Medicine
- Mayo Clinic
Multiple myeloma (MM) is characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. This clone of plasma cells proliferates in the bone marrow and often results in extensive skeletal destruction with osteolytic lesions, osteopenia, and/or pathologic fractures. Additional disease-related complications include hypercalcemia, renal insufficiency, anemia, and infections.
The International Myeloma Working Group has developed uniform response criteria, which are used to measure the effect of treatment. These criteria are described in detail here. This same group has proposed definitions of survival endpoints (ie, progression-free survival, time to progression, and duration of response) to be used in reporting clinical research. These are also defined here.
The following issues related to MM are discussed separately:
●The diagnosis of MM and the tests used to measure monoclonal proteins in the blood and urine. (See "Clinical features, laboratory manifestations, and diagnosis of multiple myeloma" and "Recognition of monoclonal proteins".)
●Indications for the treatment of MM, risk stratification, and the choice of initial therapy based on this risk stratification and patient characteristics. (See "Overview of the management of multiple myeloma" and "Selection of initial chemotherapy for symptomatic multiple myeloma" and "Treatment of relapsed or refractory multiple myeloma".)
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- RESPONSE ASSESSMENT
- Clinical assessment
- Assessing tumor burden
- - Choice of test(s)
- - SPEP, UPEP, and immunofixation
- - Free light chain assay
- - Bone marrow aspirate and biopsy
- - Imaging
- - Minimal residual disease assessment
- RESPONSE CRITERIA
- IMWG response categories
- Renal response
- SURVIVAL END POINTS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS