Followup

The follow-up of patients with multiple myeloma is dependent on a number of factors, including phase of disease (early untreated vs relapsed refractory), the stage, presence or absence of ongoing therapy, mode of therapy, and comorbidity. Patients are typically evaluated every 4-6 weeks during active therapy, and every 3-4 months when in the plateau phase of disease on no therapy or only maintenance therapy. Patients with active treatment or disease-related complications may need more frequent monitoring.

The suggested clinical and laboratory evaluations to be performed at follow-up are given in Table 86.6. These are guidelines and need to be modified according to clinical need.

Acknowledgments

This work is supported by grants CA 107476, 62242, 100080, and 93842 from the National Cancer Institute, National Institutes of Health, Bethesda, MD.

Table 86.6 Standard tests for follow-up

Routine tests to be done at each follow-up

■ Complete blood counts

■ Serum chemistries (include serum creatinine, electrolytes, and calcium)

■ Serum protein electrophoresis

■ Urine protein electrophoresis

Every 6-12 months

■ Skeletal survey

Based on clinical situation

■ Serum and urine protein immunofixation (at baseline and to document complete response)

■ Bone marrow biopsy (at baseline, as needed to clarify clinical state, and if needed to confirm

Progression/response)

■ p2-microglobulin, plasma cell labeling index, cytogenetics, circulating plasma cells, LDH, CRP (at base line, and as needed to clarify clinical state)

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