Should myeloma patients alter their treatment if their protein spike remains low but has not gone away?
In this episode, Dr. Brian G.M. Durie discusses when multiple myeloma patients with low level myeloma protein should consider changes to their treatment regimen.
The BOTTOM LINE:
There is no need to change your treatment if your myeloma protein levels remain low and stable. Consider new treatments if your myeloma progresses.
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This week’s “Ask Dr. Durie” is again, rather a common question, and it comes from several patients who want to know: “if their protein spike in the blood has not gone away, what do they need to do?”
Well, the examples are patients whose myeloma protein spike is like point one or point two grams per deciliter, so, very low levels. So, the question is: “Is that okay? Or do they need to change treatment?”
Well, I think that the most important thing to realize is that if the myeloma protein is stable in that range, maybe fluctuating point one, point three, point two, point one, just in that very, very low range and everything else is fine, there really is no urgency to jump in and make a big change. It’s important to keep in mind that although we would all love for your results to be completely zero, where the protein spike has completely gone away, and maybe if you have a bone marrow test and there’s an undetected minimal residual disease, that’s great. However, it’s also absolutely fine if your protein level is running very, very low, and you’re doing fine clinically with no anemia, no bone problems, or no other issues.
Because we really don’t want to give you some aggressive new treatment just to know your protein level a little bit lower.
The BOTTOM LINE is that we prefer to save these extra new treatments in case the myeloma is actually progressing, creating some new problems for you, and you really do need that new treatment to know that myeloma down and achieve a new response. And so, if you’re in remission, that’s great. Stick with your maintenance therapy. Stick with your ongoing protocol, no need to make a radical change. And what we know over the years is that a lot of myeloma patients can be doing just fine for many years with low numbers, without the need to do anything different in a major way.
Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.