What are the goals of treatment at relapse?

What are the goals of treatment at relapse?

The goals of treatment for a patient with relapsed myeloma, I think, are really twofold.

The first is to control whatever symptoms the patient is having. If a patient has relapsed with bone disease that's painful, kidney dysfunction, high calcium, or anemia, the primary goal, similar to the goals of therapy at the newly diagnosed stage, is to control the symptoms. That's the first and foremost. Secondly, the goal is to control the disease for a prolonged period of time.

We now, particularly for patients who have experienced their first relapse, aim to control the disease for a long period of time, similar to how we control the disease in the newly diagnosed setting for a long period of time. The goals somewhat shift in later relapses where treatments become more difficult.

As we always do, it becomes more of a balance between controlling the disease and maintaining quality of life. In addition to the two things I mentioned, trying to maintain quality of life during treatment, just as we do in the newly diagnosed setting, remains important in the relapse setting.

The first goal is symptom control because you don't want anybody to have any organ damage or any end-organ manifestations of myeloma, such as bone disease, abnormal kidney function, high calcium levels, frequent infections, or anemia. With that said, if somebody is being monitored on a regular basis, more likely than not they will not have a symptom at relapse. They'll just have what we call biochemical progression, which means the proteins in the blood or the urine are increasing to a level that's no longer acceptable.

We choose that level based on a definition of how much protein is too much protein, and that's based on certain guidelines called the IMWG criteria. They define what's considered progression or relapse of myeloma. The reason we have a set number is that we don't want patients to develop symptoms. We aim to catch the cancer before it causes harm to the body at a level much lower than when they first presented with the disease.

So when that definition is met, that's considered a relapse.

So, what are the goals of treating relapsed and refractory patients with multiple myeloma? The goal is really to give them the best response for the longest period of time while maintaining quality of life.

That's why we need to do research and clinical trials that address these three goals: quality of life, duration of life, and quality of control over the disease. I really think there are a lot of trials addressing that. So, I encourage patients with multiple myeloma to enroll in clinical trials. These are the goals.

I mean, if they do, I would find a regimen that is patient-friendly, very effective, and can lead to a lasting response.