Step 8: Monitoring
With typical novel combination therapies currently used in myeloma, the initial response tends to be quite rapid. Within 2-3 months, major response should have occurred. Treatment may be adjusted to improve tolerance for the longer term. Tests will show the monoclonal protein change since the last measurement or treatment. The Hevylite® blood test is more sensitive and precise for measuring response at a very low level of myeloma than the immunofixation electrophoresis (IFE) test, especially for IgA myeloma.
Side effects and toxicities
At all times, one must balance the need to get the myeloma into remission with the need to reduce side effects. It is crucial for patients to inform their physician about any side effects, so measures (e.g., dose adjustments) can be taken promptly. This is especially true for any type of nerve damage (neuropathy) indicated by loss of sensation, pain, or any other symptom of decreased nerve function.
Confirmation of response and follow-up testing
In general, basic testing is performed with each treatment cycle for the first 4 cycles. Unless there are new concerns, x-rays or other imaging scans are repeated only after several months have passed. Typically, bone marrow tests are repeated only to confirm if a complete response (CR) has been achieved, unless disease progression or relapse is a concern.