Every response assessment timepoint (every cycle) | If electrophoresis shows no measurable protein | At suspected CR | At suspected progression (clinical or biochemical) | |
SPEP (serum M-spike ≥1 g/dL[1])* | X | ◊◊ | X | X |
Serum immunofixation (any) | ◊◊ | X | X | X |
UPEP (urine M-spike ≥200 mg/24 hours) | X | ◊◊ | X | X |
Urine immunofixation (any) | ◊◊ | X | X | ◊◊ |
Serum FLC | ||||
Serum M-spike <1 g/dL, urine M-spike <200 mg/24 hours, but involved immunoglobulin FLC is ≥10 mg/dL | X | ◊◊ | X | X |
Any | ◊◊ | ◊◊ | X | X |
Bone marrow aspirate/biopsy | ||||
Serum M-spike, urine M-spike, or involved immunoglobulin FLC not meeting above criteria but bone marrow plasma cell percentage ≥30% | X (to be done every three or four cycles till a plateau or complete response, or as clinically indicated and then at suspected progression) | ◊◊ | X | ◊◊ |
Any | ◊◊ | ◊◊ | X | ◊◊ |
Plasmacytoma (PET imaging) | ||||
Serum M-spike, urine M-spike, involved Ig FLC or bone marrow not meeting above criteria, but at least one lesion that has a single diameter of ≥2 cm | X (to be done every three or four cycles till a plateau or complete response, or as clinically indicated, and then at suspected progression) | ◊◊ | X | ◊◊ |
Any | ◊◊ | ◊◊ | X | ◊◊ |
Hemoglobin, serum calcium, creatinine (any) | X | ◊◊ | ◊◊ | X |
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