@cat1952, I found this information on the International Myeloma Foundation's website
- What Is Relapse in Myeloma? https://www.myeloma.org/treatment/relapse-definition

"The International Myeloma Working Group consensus criteria for response and minimal residual disease assessment, published in The Lancet Oncology in August 2016, states that clinical relapse requires one or more of the following criteria. These criteria are direct indicators of increasing disease and/or end-organ dysfunction (CRAB features):

- Definite increase in the size of existing plasmacytomas (tumor composed of plasma cells) or bone lesions.
- Hypercalcemia, which is above normal calcium levels in the blood (> 11 mg/dL).
- Decrease in hemoglobin (protein in red blood cells that carries oxygen) of ≥ 2 g/dL not related to therapy or other non-myeloma-related conditions.
- Rise in serum creatinine (muscle waste product in the blood) by 2 mg/dL or more from the start of the therapy and attributable to myeloma.
- Hyperviscosity (thickening of the blood) related to serum protein.
Increase of 25% from the lowest confirmed response value in one or more of the following criteria:
** Serum M-protein (the increase must be at least 0.5 g/dL).
** Urine M-protein (the increase must be at least 200 mg/24 hours).
** If no serum or urine M-protein can be measured, the difference between the involved (abnormal, or monoclonal) and uninvolved (normal or polyclonal) free light chain levels (the increase must be >10 mg/dL).

The following may be signs that multiple myeloma is relapsing based not upon CRAB criteria, but upon biological markers.

No patient should be treated solely "by the numbers." Your disease history and your doctor's experience and judgment must guide the decision to change or re-start treatment. Multiple myeloma is different in every patient. Each patient must be evaluated as an individual, not as a statistic."

Is a change in treatment plan being considered?