Dr Brunner on the Heterogeneity of Relapsed Multiple Myeloma

Matthew Brunner, MD, assistant professor, hematologic specialist, medical oncology, and palliative care, Department of Medicine, University of Wisconsin Carbone Cancer Center, discusses the heterogeneity of relapsed multiple myeloma and the various symptoms that patients could experience.

At an OncLive® Institutional Perspectives in Cancer webinar on multiple myeloma, Brunner presented on the evaluation of patients with relapsed/refractory multiple myeloma, where he provided key updates on the treatment landscape and ways in which relapsed multiple myeloma can differ from patient to patient. Brunner notes that multiple myeloma is a heterogeneous disease even before reaching the relapsed stage, and different factors about the patient and the disease will affect how a patient’s disease responds to treatment. There are different ways that multiple myeloma could relapse, which are associated with different presentations of symptoms, varying rates of progression, and differences in aggression, Brunner says. Since relapses can present with a variety of symptoms, it is important to be aware of the different relapse-defining events that could occur across multiple patients, Brunner adds

For example, a patient can have a biochemical relapse, which can be seen through an increase in their M protein in their serum protein electrophoresis, or it can be an increase in their free light chains. Radiographic relapse can be detected with a new bone lesion, growth in old bone lesions, or the development of an extramedullary plasmacytoma, Brunner expands. Moreover, relapsed multiple myeloma could be only an increase in the number of plasma cells in the bone marrow, Brunner adds.

When a patient experiences clinical relapse, this can be marked by symptoms such as anemia, renal dysfunction, or hypercalcemia. Notably, an increase hypercalcemia can also be a symptom of plasma cell leukemia, although this is much rarer, Brunner adds. Given the different symptoms and ways multiple myeloma can relapse, it is important to be aware of the different paths the disease can take and maintain open communication with patients to ensure any changes are detected, Brunner concludes.