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 a single clone of plasma cells producing a monoclonal immunoglobulin. Potential complications include hypercalcemia, renal insufficiency, infection, and skeletal lesions. Once the diagnosis of MM is made and it is determined that the patient requires therapy, treatment options include hematopoietic cell transplantation and chemotherapy.
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.
Indications for the treatment of MM, risk stratification, and the choice of initial therapy based on this risk stratification and patient characteristics are reviewed separately. (See "Overview of the management of multiple myeloma" and "Selection of initial chemotherapy for symptomatic multiple myeloma" and "Management of multiple myeloma in resource-poor settings".)
The use of hematopoietic cell transplantation (HCT) in myeloma, chemotherapy in patients with relapsed or resistant myeloma, the treatment of complications of MM (eg, hypercalcemia, renal insufficiency, skeletal lesions), and the use of bisphosphonates are also discussed separately. (See "Autologous hematopoietic cell transplantation in multiple myeloma" and "Treatment of relapsed or refractory multiple myeloma" and "Treatment of the complications of multiple myeloma" and "The use of bisphosphonates in patients with multiple myeloma".)
Overview — The International Myeloma Working Group (IMWG) uniform response criteria are the preferred criteria to determine the patient's best response to treatment and to define when a relapse has occurred [1,2]. These criteria build upon the European Group for Blood and Marrow Transplant (EBMT) response criteria, which were widely used from 1998 until 2006 . In their revision of the EBMT criteria, the IMWG made some clarifications, added new categories of response, and incorporated the free light chain (FLC) assay [1,4]. (See "Recognition of monoclonal proteins", section on 'Serum free light chains'.)
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- RESPONSE CRITERIA
- Definition of measurable disease
- - Using M protein to assess response
- - Using FLC levels to assess response
- - Using bone marrow plasma cells to assess response
- - Imaging studies to measure response
- Response categories
- Renal response
- SURVIVAL END POINTS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS