Treatment Outcomes

With the current advances in treatment and supportive care, survival rates for myeloma patients have improved significantly in the last decades. It is not unusual for myeloma patients to live for 10 years or longer after diagnosis. Outcomes are influenced by a series of patient-specific factors, including disease stage, chromosome abnormalities, age and presence of other medical problems. Patients should discuss their own potential outcomes with their doctors.

Click here to access myeloma survival statistics.

Measuring Treatment Response for Myeloma

Your doctor must monitor your response to treatment for myeloma. By measuring your progress, your doctor can see whether any changes to your therapy are needed.

Your doctor uses the following tests to measure your treatment response:

  • Bone imaging studies, such as x-ray studies, MRI and PET scans
  • Blood and urine tests to check blood cell counts, kidney function and myeloma-cell growth
  • Bone marrow aspiration and biopsy to observe the pattern and amount of myeloma cells in the marrow

Treatment response, as determined by these well-established methods, is often supplemented with measurements of minimal residual disease (MRD). A number of techniques can be used to identify MRD, including

  • Immunophenotyping of a bone marrow aspirate by flow cytometry. Immunophenotyping uses antibodies to look for specific proteins on the surface of cells that are unique to each cell type, allowing for identification or fingerprinting of those cells. For example, it can help in determining whether plasma cells in the marrow are from left over myeloma, or if they are normal plasma cells.
  • Polymerase chain reaction (PCR) using allele-specific oligonucleotide probes (ASO-PCR), usually on a bone marrow sample. This method is used to expand trace amounts of DNA or RNA, so that the specific type of the DNA or RNA can be determined. It is useful because it allows the hematopathologist to detect a very low level of residual myeloma cells, too low to be seen with a microscope
  • Next-generation sequencing (NGS) of either a bone marrow or blood sample. This highly sensitive technique uses sequences of immunoglobulin heavy chains from B lymphocytes and plasma cells to detect the presence of malignant cells.

Your doctor may use one of the following terms in the table below to describe your response based on your test results.

Term Used to Describe Response Characteristics
Remission
  • No detectable disease
  • The terms “complete remission” (or “complete response”) and “partial remission” (or “partial response”) are sometimes used.
Stringent complete response 
  • No detectable disease by serum or urine immunofixation
  • Normal kappa (k)/lambda (λ) light chain ratio
  • No detectable myeloma on bone marrow flow cytometry
Complete response
  • No sign of M protein using standard tests
  • Disappearance of any soft-tissue plasmacytomas 
  • Less than 5% plasma cells in bone marrow aspirates
Very good partial response
  • A 90% or greater decrease in blood M protein
  • Urine M protein level <100 mg in 24-hour urine collection
Partial response
  • 50% or greater decrease of M protein in the blood
  • 90% reduction in M protein level or <200 mg in 24-hour urine collection
  • 50% or greater reduction in the size of soft-tissue plasmacytoma (if present at diagnosis)
Minimal response
  • Reduction between 25% and 50% in M protein in the blood
  • Reduction between 50% and 89% in M protein in 24-hour urine collection
  • 50% or greater reduction in the size of soft-tissue plasmacytoma (if present at diagnosis)
Stable disease
  • Not meeting criteria for complete response, very good partial response, partial response, minimal response or progressive disease
Progressive disease
  • At least a 25% increase in M protein in the blood and urine
  • Appearance of new lesions or 50% or greater increase in the size of previous lesions
  • If associated with symptoms, such as a new lytic bone lesion, usually indicates the need to start therapy or to change therapies if the patient is already receiving treatment
  • A biochemical relapse indicates that a patient has signs of relapse on blood and/or urine, but without evidence of worsening organ function 

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