Watching for Recurrence and Relapse
- The main tool that doctors have for monitoring multiple myeloma patients after they’ve undergone treatment is blood testing. Doctors can test for the abnormal protein produced by multiple myeloma cells, and they can also gauge how many plasma cells are present in the bone marrow.
- Another tool is imaging. There are challenges to common approaches to imaging like X-rays and CT scans, however. Sometimes a PET scan is needed to determine whether holes in the bones that once contained multiple myeloma still contain active cancerous cells.
- Bone marrow biopsies may be used to investigate specific symptoms or if doctors are concerned that the multiple myeloma is changing its characteristics.
Blood Tests
The main tool that doctors have at their disposal are blood tests. "After initial treatment for multiple myeloma and throughout your course, blood testing for that abnormal paraprotein or the abnormal protein made by the multiple myeloma cells will be a central part to that monitoring," said Dr. Ulrickson. "This is done through blood tests to check the serum protein electrophoresis (SPEP), as well as the free light chains at certain intervals."
Read MoreImaging
For some patients, imaging can also play a part in monitoring their progress. Dr. Ulrickson notes that there are some challenges to imaging after the initial treatment of multiple myeloma. "Imaging after initial treatment for multiple myeloma requires additional interpretation," he said. "When multiple myeloma causes disease in the bones, it creates holes in the bone. And on a plain X-ray, or for example, a CT scan, it can sometimes be challenging to know whether this is a hole that still has multiple myeloma in it, or just the crater that’s left after the multiple myeloma has been treated."
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Because of this ambiguity, doctors might rely on pet scans. PET scans can help doctors tell if there are still active multiple myeloma cells in holes in the bone, or whether the active cells have been eliminated and the bone just needs to heal.
Bone Marrow Biopsies
Beyond blood tests and imaging, some patients may be examined through a bone marrow biopsy. "Those tests with imaging and bone marrow biopsy do not need to be done as frequently as the blood tests," Dr. Ulrickson said. "But they can be done either for specific symptoms in an area of bone that may benefit from different treatment, or if there is concern that the multiple myeloma is changing its characteristics." Bone marrow biopsies can provide a deeper look into the genetic makeup of multiple myeloma cells.
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