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Biochemical Relapse in Multiple Myeloma- To Treat or Not To Treat?

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“Individuals with high-velocity multiple myeloma relapse will need immediate therapy, while patients who are asymptomatic with low-velocity reappearance (biochemical relapse) of the M protein may not require intervention”

Dear Cancer Coach- I trust all is well. Can you tell me if a biochemical relapse of my multiple myeloma is a precursor to full relapse? My Free Kappa Light chain has been spiking so we have increased the dose of Velcade ( I had been on low-dose/maintenance ) plus dexamethasone to push back.

It could be that Velcade has lost its effacacy given my long-term use.  My oncologist and I stayed with low-dose Velcade maintenance due to the fact that I tolerated it so well. In addition all my other numbers have been normal which I attribute to the multiple myeloma cancer coaching program.

I realize this may be a good question for the Facebook group (Beating Myeloma) and I may post after your response but my family follows my page and I am not trying to alarm them prematurely.

Let me know what you think. Thanks.

Dear MM CC Client-

While the excerpt below by Ajai Chari, MD, doesn’t really give a specific definition of “biochemical relapse,” I interpret the doctor’s explanation to be directed at two things. First, is the MMer asymptomatic or not and second, has the MM’s freelight chains increased out of the “normal” range. You seem to fall into both categories. No symptoms with increased kappa freelight chains.

The article linked and excerpted below talks about a relapse in MM to be about the damage or risk of damage caused by disease to be the guiding factor when consider whether or not to actively treat you MM.

Meaning you must consider your past treatment history and combine this with a determination if your disease is high risk or standard-risk MM.

If I remember our past discussions your MM is slow growing and you have been on Velcade for some time now.

Let me know if you have any questions. Good luck.


David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Biochemical Relapse of Multiple Myeloma

“In trying to decide how to treat a patient with relapse, the first question is, where is this patient on that continuum of purely biochemical relapse to fulminant disease? Not everybody with mild biochemical relapse, which isn’t even fully detectable or fully measurable by IMWG (International Myeloma Working Group) response criteria, needs immediate therapy. That type of patient could potentially be watched for a few months longer until we do have symptoms…

How & When To Treat Relapsed Multiple Myeloma

“When deciding on the optimal treatment for an individual with relapsed multiple myeloma, it is important to determine whether the relapse was biochemical in nature and whether the patient has standard-risk or high-risk disease…

An individual with high-risk disease is more likely to encounter poorer outcomes, such as organ dysfunction, and may require earlier treatment. It may not be urgent to initiate treatment for patients on maintenance therapy with lenalidomide who have a modest increase in their M protein levels…”

Other factors to consider include treatment history, duration and tolerability with previous therapies, current patient status, and renal status… Even once these factors are considered, it remains unclear how to optimally sequence all of the therapies that are available for patients who have relapsed…

Evidence of disease progression does not necessarily trigger treatmentIndividuals with high-velocity relapse will need immediate therapy, while patients who are asymptomatic with low-velocity reappearance of the M protein may not require intervention. The immunoglobulin free light chain assay is helpful as a leading indicator of progression in patients who plateau

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