Therapy selection and novel agents in relapsed and refractory multiple myeloma

摘要

Before initiating re-treatment for a patient with multiple myeloma, it is necessary to ensure that the patient truly warrants therapy for recurrent disease. There are 2 defined parameters that determine which patients have truly relapsed and therefore should be treated: clinical relapse and significant paraprotein relapse. Clinical relapse refers to the presence of symptoms such as development of a new soft tissue plasmacytoma or bone lesion on imaging, a definite increase in existing plasmacytoma, increase in the bone lesion, hypercalcemia, anemia, renal dysfunction noted by rising serum creatinine, hyper-viscosity, bone pain, or compression fracture. Paraprotein relapse is defined as patients whose M spike is doubling in 2 consecutive measurements separated by less than 2 months, or in 2 consecutive measurements, there is an absolute increase in serum M complement by more than 1 g/dL, a urine Bence-Jones protein measurement of more than 500 g/day, or increase in free light chain by 200 mg/L.