Appendix G: Tracking Disease Status for Multiple Myeloma

Successfully tracking and reporting disease status for multiple myeloma requires a understanding of the different methods of assessment, away of organizing relevant test results, and the ability to identify the correct baseline against which changes in test results can be compared. For training on how to identify and interpret myeloma disease assessment, refer to the myeloma learning modules available on the CIBMTR website under Online Training. For examples of ways to track disease assessments, refer to the documents included under Disease Status Tracking Examples below. Finally, for instructions on how to choose the correct baseline, refer to Determining a Baseline below.

Disease Status Tracking Examples

Tracking Disease Status for Multiple Myeloma – Word Document
Tracking Disease Status for Multiple Myeloma – PDF

The links above go to a flowsheet to aid in the determination of disease status for patients with multiple myeloma.

Determining a Baseline

HCT is planned as part of initial therapy w/out prior disease progression or relapse.
The baseline used to determine the best response to HCT is the disease parameters obtained at the time of diagnosis.

Patients who have not received any chemotherapy within 6 months of HCT, untreated relapse/progression or if the recipient has never been treated (rare).
The baseline used to determine the best response to HCT would be the disease parameters obtained immediately prior to the start of the preparative regimen (not the disease parameters at time of diagnosis).

What if the patient had a disease progression or relapse of disease before HCT?
If a patient had disease progression or relapse of disease & was treated to reduce the myeloma burden before any preparative regimen was given for HCT, the baseline used to determine the best response to HCT would be the disease parameters obtained at the time of the relapse or progression. In other words, the baseline is the reset to the time of the relapse or progression. Therefore, the disease parameters obtained at diagnosis or immediately prior to the start of the preparative regimen would not be used as the baseline to determine the best response to HCT.

What if the patient had 2 or more disease progressions before HCT?
The appropriate baseline to use would be the disease parameters documenting the most recent disease progression.

What if the patient’s initial therapy was changed to a different regiment due to toxicity & there was not a disease progression or relapse at any time prior to HCT, what baseline is used to determine the best response to HCT?
The baseline used to determine the best response to HCT is the disease parameters obtained at the time of diagnosis.

Tandem Transplantation w/out disease progression or relapse in between.
Since this is considered one treatment, the pre-HCT baseline for determining the best response following the second HCT would be the same baseline used prior to the first HCT (i.e. the disease parameters at diagnosis).

Example 1: A 62-year-old man is diagnosed with IgG Kappa multiple myeloma. He receives initial therapy with 6 cycles of bortezomib and lenalidomide/dexamethasone; and achieves a very good partial response (VGPR). The values used to determine disease status at transplant are the values obtained at diagnosis.

Time Point	BMBX	SPEP	SIFE	UPEP	UIFE	Skeletal Survey	Treatment	Disease Status
10/31/08	27% plasma cells	3.3 g/dL	+	336 mg/24 hours	+	Negative	Bortezomib/ Lenalidomide/Dexamethasone	Diagnosis: IgG Kappa
4/3/09	3% plasma cells
4/17/09		Negative	+	Negative	Negative			VGPR
5/13/09		Negative	+	Negative	Negative			VGPR (confirmatory)
5/17/09							Autologous HCT

Example 2: A 59-year-old woman is diagnosed with IgA Lambda multiple myeloma. She receives bortezomib and thalidomide/dexamethasone as initial treatment and achieves a CR. A few months later she has evidence of relapse. She is then treated with lenalidomide/dexamethasone and achieves a PR. The patient receives high-dose cyclophosphamide as part of an autologous stem cell harvest. The values used to determine disease status at transplant would be the values obtained at the time of relapse.

Time Point	BMBX	SPEP	SIFE	UPEP	UIFE	Skeletal Survey	Treatment	Disease Status
1/27/10		4.5 g/dL	+	Negative	Negative
2/01/10	Aspirate=18% plasma cells; biopsy= sheets of plasma cells							Diagnosis: IgA lambda
2/05/10						Negative	Bortezomib/ Thalidomide/Dexamethasone
3/05/10		2.6 g/dL	+
4/5/10		1.7 g/dL	+
5/5/10		0.5 g/dL	+
6/4/10		0.03 g/dL	+	Negative	Negative
8/18/10	1% plasma cells	0.01 g/dl	+
9/15/10		Not detected	+
10/15/10		Not detected	Negative					CR
11/15/10		Not detected	Negative				(no treatment given)	CR (confirmatory)
12/15/11		Not detected	Negative
1/15/11		1.9 g/dL	+	Negative	Negative			Relapse
2/15/11	7% plasma cells	2.2 g/dL	+			Negative	Lenalidomide/ Dexamethasone	Relapse (confirmatory)
3/15/11		1.4 g/dL	+
4/15/11		0.9 g/dL	+					PR
5/15/11		0.7 g/dL	+					PR (confirmatory)
6/15/11	3% plasma cells	0.5 g/dL	+
7/31/11							Autologous HCT

Manual Updates:
Sections of the Forms Instruction Manual are frequently updated. The most recent updates to the manual can be found below. For additional information, select the manual section and review the updated text.

If you need to reference the historical Manual Change History for any of the appendices, please reference the retired appendix on the Retired Forms Manuals webpage.

Date	Manual Section	Add/Remove/Modify	Description
2/19/2020	Appendix G: Tracking Disease Status for Multiple Myeloma	Modify	Updated this appendix and the linked documents to remove the Near Complete Remission (nCR) disease response criteria. This disease response was removed in accordance with revision 4 of the Forms 2016/2116.
6/30/17	Appendix G: Tracking Disease Status for Multiple Myeloma	Add	Added all information pertaining to Determining a Baseline. This information was taken from the retired Appendix V: Multiple Myeloma – Defining What Baseline to Use When Determining Disease Status.
6/30/17	Appendix G: Tracking Disease Status for Multiple Myeloma	Modify	Appendix W: Tracking Disease Status for Multiple Myeloma has been renamed as Appendix G: Tracking Disease Status for Multiple Myeloma.

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