Can you give an overview of the new imaging guidelines for myeloma? So the new guidelines is basically what we talked about. It's in which stage of disease do you get which imaging. So in MGUS, we usually say if a patient has a low risk, intermediate risk MGUS, it does really not make sense to do an imaging that would be an overkill because we in I don't know how many thousand patients you would find one non-secretory myeloma and usually those patients already have other issues. So it's not really worth the screening. In smoldering myeloma, we say as a screening in higher risk MGUS and smoldering myeloma, we recommend a CT. If CT is positive, then you have a myeloma because of oscillated lesions. If CT is negative, then we recommend an MRI because it's more sensitive and we would see changes before the actual bone destruction has happened. So that's kind of the sequence there. And as I mentioned in symptomatic myeloma, a CT to assess the bone disease is the most important thing. And if you have the ability to add a PET, you also get this information on the tumor burden at the same time. And then the next step is kind of after treatment where we recommend PET CT to look for how the bone disease is developed because sometimes also over treatment, even though there's no progression, still weakened bones can fracture and that CT gives us a good baseline for when the disease comes back later on at the relapse and the PET gives us information about residual activity after treatment. And at relapse, it's basically the same as at first diagnosis. We want to know the tumor burden. We want to know the bone involvement. So either CT or if available, PET CT.
HealthTree • June 22, 2020