How often should blood tests and PET scans be performed following a response to treatment?
Once patients have completed their induction therapy and a stem cell transplant (if they were eligible for one) and begin maintenance therapy, blood tests are usually performed once a month. After about a year of maintenance therapy, the frequency of testing goes down to once every three months. Patients who have high-risk myeloma (for example, those who have the chromosome 17 deletion or other high-risk features) will be checked more frequently.
PET scans are not performed routinely after a response to initial treatment. PET scans are performed only when there is a change in lab values (such as M protein values begin to rise). At this time a PET scan will be conducted to see if the rise in M protein represents a significant relapse (that is, new lytic lesions in the bones can be visualized).
How common is a partial response versus a complete response to treatment?
One of the most exciting things about myeloma therapy in 2023 is that, more than ever before, patients are achieving a very good partial response or better (a reduction of M protein in the blood by 90% or more) with treatment! The reason for these incredible responses is due to the availability of a variety of drugs that can be combined into three- and four-drug regimens. Ultimately, the type of response a patient achieves will depend on which regimen is given, but the use of these regimens can lead to a very good partial response and complete response in approximately 70% to 80% of patients. Furthermore, with the use of minimal residual disease (MRD) testing (that is, a test that can determine the number of multiple myeloma cells or DNA sequences still present in bone marrow after treatment), patients are reaching a deeper level of response called MRD negativity (no multiple myeloma cells or DNA sequences can be detected in the bone marrow). Patients who are MRD negative following treatment have been shown to live longer than those who remain MRD positive.
How can myeloma patients reduce the pain and stress of a bone marrow biopsy?
Undergoing the procedure of a bone marrow biopsy is one of the most stressful tests myeloma patients have to endure during their journey. The reason it is stressful is that the procedure, unfortunately, is associated with pain and anxiety. Many institutions have the means to reduce pain and anxiety in their patients, so if you are concerned, you need to have an upfront discussion with your care team in order to meet your needs. Luckily, there are many ways, both with and without medication, to prevent pain and anxiety during a bone marrow biopsy. Some examples are listed below.
To find the right solution for you that your institution offers, please discuss your options for pain control with your care team.