Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:17

Myeloma and Gammopathies 1035

Radiotherapy

■Involved field: (45–50 Gy) for solitary plasmacytoma; 30 Gy for palli-

ation

■Total body irradiation: component of preparative regimen for trans-

plant

follow-up

■Quantitative immunoglobulins and quantitation of M protein (with

alternate cycles of therapy and every 3 months thereafter)

■Complete blood count, differential, platelets

■BUN, creatinine, calcium

■Bone survey annually or for symptoms

■Bone marrow biopsy as clinically indicated

Maintenance Therapy

■Steroids: every other day prednisone modestly prolongs progression

free survival after conventional therapy

■Interferon: slight prolongation of progression-free, but not overall,

survival; multiple adverse sequelae

complications and prognosis

Response

■Complete response: Disappearance of monoclonal protein and plas-

macytomas, <5% bone marrow plasma cells, and no increase in size

and number of bone lesions for at least 6 weeks

■Partial response:≥50% reduction in serum monoclonal protein,

reduction in 24 hour urinary light chain excretion by either >90%

or to <200 mg/24 h, >50% reduction in size of plasmacytomas, and

no increase in size or number of lytic lesions for at least 6 weeks

■Minimal response:≥25% to≤49% reduction in serum monoclonal

protein, 50 to 89% reduction in 24 h light chain excretion (which

still exceeds 200 mg/d), 25 to 49% reduction in size of plasmacy-

tomas, and no increase in size or number of lytic lestions for at least

6 weeks

■No change: not meeting criteria for minimal or partial response

■Disease progression: reappearance of monoclonal protein; a sus-

tained > 25% rise in monoclonal protein in serum or urine; develop-

ment of new sites of lytic disease or hypercalcemia

Salvage Therapy for Progressive Disease

■Repeat primary conventional dose therapy (if relapse at >6 months)