Treatment of Multiple Myeloma with High-Risk Cytogenetics - Episode 4
Robert A. Vescio, MD:The patient decided, as mentioned, to continue on lenalidomide and dexamethasone without the proteasome inhibitor. She was followed and felt well. A few years later, her markers for her disease started to increase. Her monoclonal protein went from 0.5 g/dL to 0.7 g/dL to 0.9 g/dL. She felt well. She really didn’t have any complaints, but it was clear that her disease was growing, and so a decision had to be made regarding treatment.
Historically, patients were not always treated when their disease was growing, as determined by tests, if they felt well. We didn’t have drugs that would be well tolerated, and chemotherapy drugs have a bit of a limited life span. They can cause harm when you give them for a long period of time. I personally believe, and I think most data back this up, that if a patient’s disease is growing, even if they feel well, they should be started on treatment to get their cancer back under control.
When you’re deciding whether to start somebody on treatment, particularly when they’re feeling well, I think it is important to be certain that the cancer is growing. A lot of the ways that we follow this disease are through lab tests. There are errors in the testing. Certainly, mistakes can happen in the lab, so in studies and certainly in practice, one should be certain that the markers are getting worse. Usually, in studies, you have to have confirmatory testing to prove that the cancer’s growing back.
Once the monoclonal protein spike has doubled or whatever light chain that their myeloma is making has significantly increased, that’s enough information to embark on treatment.
Transcript edited for clarity.
A 55-year-old African-American Woman With Relapsed Multiple Myeloma