Treatment Outcomes

With the current advances in treatment and supportive care, survival rates for myeloma patients have improved significantly in the last decades. It is not unusual for myeloma patients to live for 10 years or longer after diagnosis. Outcomes are influenced by a series of patient-specific factors, including disease stage, chromosome abnormalities, age and presence of other medical problems. Patients should discuss their own potential outcomes with their doctors.

Click here to access myeloma survival statistics.

Measuring Treatment Response for Myeloma

Your doctor must monitor your response to treatment for myeloma. By measuring your progress, your doctor can see whether any changes to your therapy are needed.

Your doctor uses the following tests to measure your treatment response:

  • Bone imaging studies, such as x-ray studies, MRI and PET scans
  • Blood and urine tests to check blood cell counts, kidney function and myeloma-cell growth
  • Bone marrow aspiration and biopsy to observe the pattern and amount of myeloma cells in the marrow

Treatment response, as determined by these well-established methods, is often supplemented with measurements of measurable residual disease (MRD). A number of techniques can be used to identify MRD, including

  • Flow cytometry (immunophenotyping) of a bone marrow aspirate. This lab test identifies cancer cells based on markers called “antigens.” Antigens are proteins found either on the surface of or within white blood cells. Finding (or not finding) certain antigens can help identify cancer cells. The pattern of the surface proteins is called the “immunophenotype.” Flow cytometry can detect abnormal plasma cells by identifying certain antigens on the outer surface of cells.
  • Next-generation sequencing (NGS) of either a bone marrow or blood sample.  Next-generation sequencing, also called “molecular testing” or “genomic testing,” refers to a number of different laboratory tests that examine the exact sequence (order) of DNA or RNA. This makes it possible to identify a variety of genetic changes in a patient’s cancer cells. With NGS, researchers can sequence DNA and RNA much more quickly and cost effectively than they could with older technologies. It identifies mutations present in the genes of the myeloma cells. Next-generation sequencing is being done now on a research basis but may soon be used in routine clinical practice

Your doctor may use one of the following terms in the table below to describe your response based on your test results.

Term Used to Describe ResponseCharacteristics
Remission
  • No detectable disease
  • The terms “complete remission” (or “complete response”) and “partial remission” (or “partial response”) are sometimes used.
Stringent complete response 
  • No detectable disease by serum or urine immunofixation
  • Normal kappa (k)/lambda (λ) light chain ratio
  • No detectable myeloma on bone marrow flow cytometry
Complete response
  • No sign of M protein using standard tests
  • Disappearance of any soft-tissue plasmacytomas
  • Less than 5% plasma cells in bone marrow aspirates
Very good partial response
  • A 90% or greater decrease in blood M protein
  • Urine M protein level <100 mg in 24-hour urine collection
Partial response
  • 50% or greater decrease of M protein in the blood
  • 90% reduction in M protein level or <200 mg in 24-hour urine collection
  • 50% or greater reduction in the size of soft-tissue plasmacytoma (if present at diagnosis)
Minimal response
  • Reduction between 25% and 50% in M protein in the blood
  • Reduction between 50% and 89% in M protein in 24-hour urine collection
  • 50% or greater reduction in the size of soft-tissue plasmacytoma (if present at diagnosis)
Stable disease
  • Not meeting criteria for complete response, very good partial response, partial response, minimal response or progressive disease
Progressive disease
  • At least a 25% increase in M protein in the blood and urine
  • Appearance of new lesions or 50% or greater increase in the size of previous lesions
  • If associated with symptoms, such as a new lytic bone lesion, usually indicates the need to start therapy or to change therapies if the patient is already receiving treatment
  • A biochemical relapse indicates that a patient has signs of relapse on blood and/or urine, but without evidence of worsening organ function 

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