Can Myeloma Progression Be Monitored Using Only Blood Testing?

This week's "Ask Dr. Durie" comes from a patient who wants to know if, with just blood testing, you can safely monitor the status of the myeloma. And increasingly, this is becoming a very important question. At the time of diagnosis, a bone marrow test is necessary. Also, X-rays or MRI, CT, or PET/CT are required to assess any impact on bones. 

But after that, blood testing can be highly successful in tracking the disease. We need to know the level of the blood count, and the chemistry panel to tell us about kidney function and calcium. And then we need the serum protein electrophoresis, immunofixation, and serum free light level, just to assess the direct status of the myeloma protein level and the light chain levels. 

With all of that, we really can do a pretty good job in assessing if myeloma is responding and if it's staying in remission or if there's any tendency toward relapse. However, we do need to pay close attention to any symptoms. So, for example, if there's any new bone pain, then X-rays or scans might need to be done to see if, despite good blood results, something is happening with the bones. 

And so, this is something very, very important. So, if any new symptoms are emerging, it is very important to tell the doctor about them so that further testing can be done as necessary. Now, moving forward, we do have some exciting new testing possibilities. And so, one is using mass spectrometry which will be available, I hope, by sometime next year. 

And this is a very, very sensitive test to measure the level of the myeloma protein in the blood. In addition, we have another new test where we can measure if any myeloma cells in the circulation—have popped into the bloodstream. And this is something that can happen if the myeloma is active. And again, I'm hopeful that perhaps by next year this will be an available test. 

And then a third thing that is possible is to check the bloodstream for DNA mutations, rather than having to do bone marrow and FISH testing. You can study the DNA mutations with a blood sample. So those three tests can add to what we have available and make precise blood testing a reality. And so, the BOTTOM LINE is we are moving strongly toward a more complete reliance on blood testing to monitor myeloma. 

And I think that within the next year or two, we will be able to do a very, very good job and only need to have an occasional extra bone marrow test to see what's going on or maybe some additional X-rays or scans to make sure that no bone marrow or soft tissue damage is occurring. So, I'm looking forward to where the much simpler approach of blood testing will be precise and usable, and a much friendlier approach for myeloma monitoring.