How is myeloma bone disease monitored? How often and what testing to use to monitor myeloma bone disease is an area of controversy? In this video, you will get to listen to different expert opinions on this topic. On average, patients with myeloma bone disease, which is the majority of patients, have some cross-sectional imaging done, sometimes just x-rays, to evaluate the status of their myeloma bone disease. On average, we don't really see things get better in the majority of patients. We're just monitoring if things are getting worse. And so sensitive cross-sectional imaging with CAT scans and MRIs often provide the best detail on when things are getting worse. And that's when we usually need to change systemic therapy and or restart some of their myeloma bone disease-directed therapy like Zometa and X-Giva. In the old days, we had x-ray and we saw whole body x-ray and we found, okay, myeloma is there, there, there, there. And then we saw over the course of the disease, unfortunately, it got worse. Nowadays, we know with CT, whole body low dose CT or CT as part of a PET CT, if it's a good quality, we can monitor it over time and we see even healing processes. That's something new that we didn't know before because the x-ray was not sensitive enough. But in CT, we have such a resolution that we can see at the rim of an osteolytic lesion that there's risklerosis. So the body tries to stabilize those osteolytic lesions. And so that's kind of a new monitoring area that we go to. We see starting of bone or a beginning of bone healing. So of course, when there's first diagnosis and when there's relapse, we have to see, okay, what has gotten worse. But nowadays, even after treatment, we can see, okay, what's getting better. Usually, we monitor bone disease in certain intervals. When patients have a baseline evaluation and start treatment, we monitor bone disease after stop of the treatment to see whether there is, for instance, an apet CT reduced activity or what happened with the lytic lesions. Are there new lytic lesions or are they stable? When patients are off treatment, it's a matter of discussion and controversies. How often we should repeat a PET CT, skeletal survey, or a CT scan. But the International Myeloma Working Group agreed, and the paper is right now in press, that probably we will repeat the PET CT yearly. It depends if you're on a remission, for instance, for many, many years. You might stretch the interval. But for right now, a yearly imaging of your skeleton is recommended. Why is this? You might be in complete remission, and we might not really feel that there might be progression of the disease. But it's also important to diagnose the quality of your bones. And it's also important to see whether there are any fractures, for instance, compression fractures in your spine that might not be really detected otherwise. So that's why a regular follow-up via imaging is important for monitoring your bone disease. Myeloma bone disease is a challenge to monitor, because there's no single modality that works for every patient. PET scans have a false negative rate, even at the best of institutions of 10%. And most of our institutions aren't the best. The false negative rate is much higher due to the type of myeloma and due to the fact that radiologists only look at where the uptake is of the radioactive dye, not just whether they have cold myeloma disease. So that's a PET scan. And there's only so many PET scans that oftentimes patients can get due to pair restrictions. MRIs are challenging because they take a long time and they provide a very in-depth look, but at a very small proportion of the patient's body. Certain centers are able to perform CAT scans of the entire skeleton, a CT low-dose skeletal survey, as it were. This is not currently available to most institutions because there's no way to bill for it. But that is probably the most quickest and easiest way to monitor myeloma bone disease over time. But it's only available at a select number of institutions that are able to provide it, essentially, for free to patients. We're hoping to advocate for a CT low-dose scan to be done because the data internationally shows that those CT scans of the skeleton are much more sensitive and accurate than x-rays, the so-called skeletal survey. So how often to evaluate myeloma bone disease and with what imaging modality is very complicated and different for each patient. The only thing that I know I don't like is doing a scheduled annual scan of patients Disregarding the status of the patient's disease or the type of myeloma that they have, I find that that has very little evidence to support it.