- Which laboratory test is the most important to monitor for disease progression?
The answer depends on each patient and what type of myeloma they have at the time of their diagnosis. For example, for patients with IgA or IgG myeloma and kappa or lambda light chains, the M protein value (as measured by serum protein electrophoresis [SPEP]) is what is followed. If the M protein value begins to rise at some point after treatment, that is a sign of a relapse. An M protein value that rises by 0.5 will get the doctor’s attention (this threshold is just an estimate, so check with your doctor) and the SPEP test will be repeated. Most lab tests are repeated to confirm that the original finding is a true value versus it being just a “bad day in the lab” at that time.
For patients who only have light chain myeloma, the free light chain test is used and that is the value that is followed and any rise in value would signal a relapse and would necessitate the test be repeated.
One important point to note is that for patients who’ve had IgG or IgA myeloma for a long time, they may transition to producing light chains only (this is called light chain escape—the occurrence is uncommon, however) and these patients would need to be assessed by the free light chain test rather than SPEP (for M protein) in order to monitor for disease relapse.
- What is considered a low level of M protein to be considered a response?
The goal of myeloma treatment is to reduce the amount of M protein (or light chains) to the lowest level possible. The actual value will be different for every patient.
- For patients who’ve had imaging tests conducted (for example: x-rays, PET/CT scans, MRI), is it advantageous to have the results read by a myeloma specialist?
Most myeloma doctors rely heavily on radiologists for their assessment of imaging test results. Even though radiologists do not treat myeloma patients, most are very skilled and highly trained to observe and evaluate changes that occur over time.