Dr. Melissa Alsina, of Moffitt Cancer Center, explains how myeloma patients are monitored once treatment has begun.
Dr. Melissa Alsina is an associate professor of medicine in the Blood and Marrow Transplant Program at Moffitt Cancer Center in Tampa, Florida where she also serves as head of the Multiple Myeloma Transplant Program. Learn more about Dr. Alsina, here.
When a patient is in active myeloma treatment, how are they monitored?
So, myeloma is actually a disease that has really good markers, because the cells that cause myeloma are called plasma cells. These cells are part of our immune system, and their normal function is to produce antibodies, which is a type of protein, and these proteins we can measure in the blood or in the urine of the patients. So, when a patient is diagnosed, we would say, “Okay, you have IgG kappa myeloma,” for example. IgG is a type of antibody. This antibody is what we call immunoglobulins, the more fancy name for antibodies, and we abbreviate that like “Ig,” and then we name them by letters, like IgG, IgA.
So, when a patient is diagnosed, I am able to check out the blood and see what is the type of antibody that has been secreted by the particular patient’s myeloma cells, and that would tell me the type of myeloma the patient has. So, if the patient has, for example, IgG kappa myeloma, then I can follow that IgG after the patient gets therapy, and also the kappa light chain, and I would know if the treatment is working or not because if the treatment is working, the levels of those proteins should go down.
There’s some more fancy – another test that we do that is called serum protein electrophoresis that gives us the monoclonal protein, or the M-spike, and that is very exact. That tells me exactly what is the amount of protein secreted by the myeloma cells, and I can measure that, and that’s how we measure response. We say if the M-spike drops by more than 50 percent, the patient has a partial response, if it drops by more than 90 percent, the patient has a very good partial response, and if the M-spike goes away completely, that is a complete response or complete remission, which is the goal of therapy.