From the Guidelines
Assessing multiple myeloma progression involves a combination of tests to evaluate the extent of disease and response to treatment. The most important tests include detection and evaluation of the monoclonal (M-) component by serum and/or urine protein electrophoresis, evaluation of bone marrow plasma cell infiltration, and assessment of lytic bone lesions through radiological skeletal survey or magnetic resonance imaging (MRI) 1.
Key Tests for Assessing Multiple Myeloma Progression
- Serum and urine protein electrophoresis: To detect and quantify the monoclonal protein (M-protein) component, which is crucial for tracking the progression of myeloma and response to treatment 1.
- Bone marrow aspiration and biopsy: To evaluate bone marrow plasma cell infiltration and detect quantitative and/or qualitative abnormalities of bone marrow plasma cells 1.
- Radiological skeletal survey or MRI: To assess lytic bone lesions and detect early radiological progression, with MRI providing greater detail, especially in cases of suspected spinal cord compression 1.
- Serum free light chain (FLC) assay: Useful for screening, prognostic value, and monitoring patients with light chain amyloidosis and oligosecretory myeloma 1.
- Complete blood cell count, serum creatinine, and calcium level: To assess overall health and potential organ damage related to myeloma 1.
Monitoring Disease Progression
For patients with measurable monoclonal protein, serial studies using the same method (e.g., electrophoretic studies, quantitative immunoglobulins) are recommended to assess response 1. Bone marrow examination is not routinely needed unless there's an indication to change treatment or to establish complete response 1. Skeletal imaging, such as low-dose skeletal computed tomography (CT), is recommended yearly to detect early radiological progression, even in asymptomatic patients 1.
High-Risk Features and Prognosis
Certain chromosomal abnormalities, such as deletion of chromosome 13, deletion of 17p13, and specific translocations involving the IGH gene, are associated with poor prognosis and are considered high-risk features 1. The presence of these abnormalities can guide therapy and influence the prognosis of patients with multiple myeloma.
From the Research
Assessing Multiple Myeloma Progression
To assess the progression of multiple myeloma, several methods can be employed, including:
- Laboratory testing, such as protein electrophoresis, serum free light chain, and cytogenetic testing 2
- Evaluation of patients with possible multiple myeloma, including measurement of hemoglobin, serum creatinine, serum calcium, and serum free light chain levels; serum protein electrophoresis with immunofixation; 24-hour urine protein electrophoresis; and full-body skeletal imaging with computed tomography, positron emission tomography, or magnetic resonance imaging 3
- Assessment of circulating tumor plasma cells (CTPCs) and peripheral blood measurable residual disease (PBMRD) using highly sensitive multicolor flow cytometry (HS-MFC) 4
Biomarkers and Risk Stratification
Biomarkers such as β2 microglobulin, albumin, and lactate dehydrogenase can be used in conjunction with malignant plasma cell genomic features to assess estimated progression-free survival and overall survival 3
- The Revised International Staging System combines data from these biomarkers to classify patients into different stages of multiple myeloma 3
- CTPC and PBMRD assessment can provide a robust, noninvasive biomarker for newly diagnosed multiple myeloma patients not planned for an upfront transplant 4
Monitoring Disease Progression
Sequential PBMRD monitoring has great potential to improve the impact of existing risk stratification and response assessment models 4
- Longitudinal sampling and single-cell RNA sequencing can be used to profile plasma cells and immune cells at different disease stages, providing insights into disease progression and the immune environment 5
- Tracking plasma cell subpopulations across disease stages can reveal patterns of stability, gain, or loss, and identify potential targets for treatment 5