What discussions should I be having with my doctor at relapse?

What discussions should I be having with my doctor at relapse?

So relapse is always a very hard thing to hear. especially after if you've done good for so long, but also if you've done not so good and had only a short response. So I believe, the most first, most important thing is to look at what kind of a relapse are we talking about? Is it numbers going up or is it things that a little bit more urgent?

Is there a need for radiation or surgery? are any of the other organs sort of in peril, like are the kidneys in peril, other nerves in peril, is the heart okay? because sometimes those take precedence over myeloma therapy and need to be addressed more urgently.

I believe then the next thing would be to look at what kind of disease are we talking about?

Is this the same disease we were treating six months ago? Six years ago? Is this a new disease? And what has changed in the disease? So I'm usually a big proponent of doing biopsies to understand a tumor biology and the tumor genetics, because that help us give a lot of, data as to what to do going forward.

Then, as I mentioned, I'm a big proponent of clinical trials. So seeing if there's a clinical trial available at that point and how that may benefit the patient. So, you know, looking at if that is something a therapy that we think would be good for this specific patient. Cellular therapies, bispecifics, celmods, all these are moving closer and closer upfront and trying to decide that is also important.

However, we should we should also keep in mind that access is a very significant, you know, burden for some people. clinical trials are not available everywhere. And while they're good treatment option, it might entail driving three hours once a week, which is not something everybody can do. So also discussing standard of care options and what these options would look at.

You have a big array of them, and deciding which one is the best for the patient and understanding why we are picking that one over the other one. Is it because of, you know, trying to mitigate the risk of neuropathy, try to mitigate the risk of any cardiac toxicity, trying to, mitigate a specific risk factor pertaining to cytogenetics.

So I think that it's to me, it's more sort of a shared decision making between patients and doctors. and trying to understand why you made said decisio and what that's going to look for you and what price are you paying for it. So the same terms of any potential side effects or having, having to come in more often or not, is very important to know.

I think that a patient should ask the doctor if this is a scary relapse, or if this is a slow biochemical relapse, and they can use different terms if they want to.

But but that's really how physicians generally subdivide relapse from myeloma in their minds. Is it a slow relapse that we can watch and think about and spend some time trying to work through?

What is the next best step going to be, or is this a relapse where we really need to get on it quite quickly? That can change for an individual person over the course of their disease. patient's biology affects the type of relapse that that may occur, and patients prior treatments can sometimes affect the type of relapse that that can occur.

We're lucky in that we're living in an age where people can very frequently see all of their myeloma labs normalize, and that's unquestionably a good thing. But it does mean that when the labs start to change, people get really worried about it and they want to know, is this important or is this not important? And I think asking the physician for their perspective on that can be helpful, rather than just feeling like you're being left in the dark to to guess whether it's a big deal or not.