From the Guidelines
Biochemical relapse in Multiple Myeloma is defined as a rise in serum or urine paraprotein in the absence of clinical signs or symptoms of myeloma.
Key Characteristics
- Defined by IMWG criteria as an increase in serum or urine paraprotein levels without clinical signs or symptoms of myeloma 1
- No set level of serum or urine paraproteins consistently corresponds to the development of symptoms 1
- Treatment should be individualized, considering factors such as patient tolerance, rate of rise of myeloma markers, cytogenetic risk, and patient preference 2, 3 ### Diagnostic Criteria
- Increase of 25% from lowest confirmed response value in serum M-protein (absolute increase must be ≥0.5 g/dL) or urine M-protein (absolute increase must be ≥200 mg/24 h) 4
- Appearance of a new lesion(s), ≥50% increase from nadir in SPD of >1 lesion, or ≥50% increase in the longest diameter of a previous lesion >1 cm in short axis 4 ### Treatment Approach
- High-risk patients, such as those with high-risk cytogenetics and early relapse post-transplant/initial therapy, should be treated immediately 1, 2, 3
- Close observation is appropriate for patients with slowly progressive and asymptomatic relapse, with frequent assessment of myeloma paraprotein levels and monitoring of symptoms and organ function 1, 2, 3
From the Research
Definition of Biochemical Relapse
- Biochemical relapse in Multiple Myeloma (MM) refers to the asymptomatic increase in paraprotein levels or other biochemical markers, indicating disease progression without clinical symptoms 5, 6.
- According to the International Myeloma Working Group (IMWG), biochemical progression is defined as an increase in paraprotein levels or other biochemical markers, whereas clinical relapse is characterized by the presence of symptoms such as hypercalcemia, renal impairment, anemia, or bone lesions 6, 7.
Characteristics of Biochemical Relapse
- Biochemical relapse is often detected through regular monitoring of paraprotein levels, free light chain ratios, or other biochemical markers 5, 8.
- Patients with biochemical relapse may not exhibit clinical symptoms, but the disease is still progressing, and treatment may be necessary to prevent end-organ damage 9.
- The presence of biochemical relapse can be an indicator of underlying disease biology, and early treatment may be beneficial in preventing clinical symptoms and improving overall survival 5, 9.
Comparison with Clinical Relapse
- Clinical relapse is characterized by the presence of symptoms such as hypercalcemia, renal impairment, anemia, or bone lesions, and is often associated with a poorer prognosis compared to biochemical relapse 6, 9.
- Patients with clinical relapse tend to have shorter overall survival and progression-free survival compared to those with biochemical relapse 8, 9.
- The type of relapse (biochemical or clinical) can influence treatment decisions, with biochemical relapse potentially allowing for earlier intervention and improved outcomes 5, 7.