Do you change treatment for confirmed biochemical progression in patients with otherwise secretory MM even if the M-spike is <0.5 g/dL?

I agree- these decisions should be individualized. However, the reason I posted this comment is to draw attention to the problem which hematologists and oncologists have all but ignored - a huge problem with overtreatment. 30%+ what we do is unnecessary and quite likely harmful. We are not short on advice on which line of Rx to offer - all the way to CAR-T these days, but rarely do we read what should not be done. [I am referring to all fields in hematology and oncology, not necessarily to myelo...

I don’t necessarily think of one type of bio chemical progression differently than any other, whether it is light chains or M spike. What is more important to me is the pace of increase. Somebody who has a jump of 10 mg/dL in their difference in free light chains over six months is very different than somebody where it happens in one month. It also depends on what regimen the patient is on. If they are enjoying a good quality of life, and there are no other issues going on, then, continuing obse...

Since technically, the minimum absolute M-spike increase needed to define PD is 0.5 g/dL, I assume this refers to a scenario where the difference in free light chains (dFLC) meets criteria for PD (e.g., ≥100 mg/L rise and ≥25% rise) but the patient has a history of a measurable M-protein and the M-spike hasn't yet risen ≥ 0.5 g/dL? @Dr. First Last let us know if this is what you were referring to!

If so - my short answer is yes. FLC kinetics move more quickly than M-spike kinetics, so a rising F...