From the Guidelines
Multiple myeloma lesions are monitored during follow-up with regular imaging studies, such as [18F]FDG-PET/CT, to assess treatment response and detect early signs of progression, as recommended by the EHA-ESMO Clinical Practice Guidelines and the IMWG 1.
Follow-up Imaging
The goal of follow-up imaging is to evaluate whether lesions are responding to treatment, remaining stable, or progressing.
- Complete response is characterized by resolution of lesions on imaging,
- partial response shows some improvement but with persistent abnormalities,
- stable disease indicates no significant change,
- while progressive disease shows new lesions or growth of existing ones.
Treatment Adjustments
Treatment adjustments are made based on these findings -
- if lesions are responding, the current treatment regimen is continued,
- if progressing, therapy may be changed.
Additional Testing
Follow-up also includes blood tests for paraprotein levels, complete blood counts, calcium levels, and kidney function, as these correlate with disease activity.
- Bone healing in responding lesions can take months to years, and some lesions may leave permanent structural changes even after successful treatment.
Frequency of Follow-up
The frequency of follow-up imaging depends on the patient's risk of progression and response to treatment, with more frequent imaging recommended for patients at higher risk of early progression 1.
Imaging Modalities
The choice of imaging modality depends on the patient's symptoms and disease characteristics, with [18F]FDG-PET/CT being a preferred modality for detecting early signs of progression 1.
Clinical Relevance
Regular follow-up imaging is essential for monitoring disease activity, detecting early signs of progression, and guiding treatment decisions to improve patient outcomes in multiple myeloma 1.
From the FDA Drug Label
The time to event analyses and response rates from the relapsed multiple myeloma study are presented in Table 12 Response and progression were assessed using the European Group for Blood and Marrow Transplantation (EBMT) criteria. Complete response (CR) required <5% plasma cells in the marrow, 100% reduction in M-protein, and a negative immunofixation test (IF-). For the 121 patients achieving a response (CR or PR) on the bortezomib arm, the median duration was 8 months
The FDA drug label does not directly answer what happens with multiple myeloma lesions on follow-up. However, based on the available information, it can be inferred that:
- The response rate was significantly higher on the bortezomib arm regardless of beta2-microglobulin levels at baseline 2.
- The median duration of response for patients achieving a response (CR or PR) on the bortezomib arm was 8 months 2.
- There is no direct information on the specific outcome of multiple myeloma lesions on follow-up. It is essential to note that the provided information does not directly address the question, and any conclusion drawn may not be entirely accurate.
From the Research
Multiple Myeloma Lesions on Follow-Up
- The provided studies do not directly address the specific question of what happens to multiple myeloma lesions on follow-up. However, they do discuss the treatment and management of multiple myeloma, including the use of various drug combinations and autologous stem cell transplantation 3, 4, 5, 6, 7.
- In the study by 3, the combination of bortezomib, lenalidomide, and dexamethasone (VRd) was shown to improve progression-free survival and overall survival in patients with newly diagnosed multiple myeloma.
- The study by 4 discusses the diagnosis and management of multiple myeloma, including the use of imaging techniques such as computed tomography, positron emission tomography, and magnetic resonance imaging to evaluate bone lesions.
- The study by 5 compares the efficacy of two different drug combinations, VRd and carfilzomib, lenalidomide, and dexamethasone (KRd), in patients with newly diagnosed multiple myeloma.
- The studies by 6 and 7 discuss the use of VRd as induction therapy prior to autologous stem cell transplantation in patients with newly diagnosed multiple myeloma, and report favorable response rates and tolerability.
Treatment Outcomes
- The studies suggest that treatment with VRd or other drug combinations can lead to significant responses, including partial and complete remissions, in patients with newly diagnosed multiple myeloma 3, 6, 7.
- The depth of response can increase over time, with more patients achieving very good partial responses or better after multiple cycles of treatment 7.
- However, the studies do not provide specific information on the fate of multiple myeloma lesions on follow-up, such as whether they resolve, persist, or progress over time.