Multiple Myeloma: How Are Patients Monitored after Treatment?

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Monitoring after Multiple Myeloma Treatment

After you’ve received treatment for multiple myeloma, it’s important for you and your doctors to know where you are in terms of the number of cancerous cells still in your body because the deeper the response, the better the outcome. That’s where consistent monitoring comes in.
Minimal residual disease (MRD) is when a small number of nearly undetectable cancer cells are found after treatment. Before you get to an MRD level of response, you might first reach a “complete response” and then a “stringent complete response” level.
There are multiple ways to monitor someone after multiple myeloma treatment. A bone marrow biopsy is the best way to test for MRD, according to one of our experts, but it’s not necessarily needed to test for clinical recurrence.

After you’ve received treatment for multiple myeloma, it’s important for you and your doctors to know where you are in terms of the number of cancerous cells still in your body. But what that monitoring looks like can vary from person to person.

Dr. Tareq Al Baghdadi, a medical oncologist and hematologist at St. Joe's Mercy Hospital in Ann Arbor, Michigan, explains exactly why monitoring is important and what the process looks like.

What Does Minimal Residual Disease Mean?

A small number of nearly undetectable cancer cells found after treatment is known as minimal residual disease (MRD), and, according to Dr. Al Baghdadi, the value of minimal residual disease is a part of the story of a person’s depth of response to treatment. And that depth can be defined by the uniform criteria developed by the International Myeloma Working Group to define the levels of response.

“We’ve learned early on that patients who achieve a response will do better than patients who have stable disease,” he explained. “We reach something called a complete response, and then we define stringent complete response, and now we talk about minimal residual disease, which is [being] able to find a single myeloma cell in a hundred thousand normal cells.

“And the story has been consistent: The deeper the response, the better the outcome. And currently the deepest response we can achieve is what we call a minimal residual disease negative stringent complete response.”

What Does Monitoring Look Like?

In general, all multiple myeloma patients are followed at regular intervals to monitor their disease. Dr. Al Baghdadi says the best way to check for minimal residual disease is with a bone marrow biopsy followed by a flow symmetry test or otherwise with a PCR test if you “have a genomic abnormality that you can test for.”

Minimal residual disease can also be assessed by next generation sequencing (NGS). This type of sequencing is most commonly available as a test through Adaptive Clonoseq, both in clinical trials and clinically.

“Most trials have looked for flow cytometry-based minimal residual disease determination,” Dr. Al Baghdadi said. “Again, the deeper the response that we achieve, the longer the patient stay[s] in remission and the longer their survival is.”

Dr. Al Baghdadi says the best use of a bone marrow biopsy is to look for minimal residual disease. But a bone marrow biopsy is not necessarily needed to diagnose a clinical recurrence.

“Once they achieve a response, we can monitor disease in the blood by running a test called protein electrophoresis or serum free light chains. We also monitor the kidney function, blood counts and the calcium level. But we can also monitor using imaging studies like PET scans and MRIs.”

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