Table 3.

Summary of observations and recommendations

Pertinent Observations in Current Study	Potential Impact of Observation on Current Practice and Guidelines
The majority (98%) of R/POD is associated with serologic evidence of R/POD	Serologic follow up may be sufficient to monitor patients
The majority (85%) of patients with R/POD have asymptomatic R/POD. Symptomatic disease is associated with younger age, poor cytogenetics and shorter PFS and post-R/POD survival	Younger patients with poor cytogenetics may need closer monitoring
New proposed criteria for relapse in patients with FLC only disease (Currently there are no IMWG criteria available)	New criteria using FLC assay could be used to detect relapse even in patients with measurable M spike
Annual skeletal survey was not useful in any patients to predict R/POD	Annual skeletal survey is not recommended for routine monitoring
Urine testing was not useful to predict R/POD except in a few patients in CR	Routine urine testing is possibly not recommended for routine monitoring
The association between patterns of paraprotein at diagnosis and relapse is predictable and versatile	Allows to predict patterns of paraprotein at relapse and mitigates the current IMWG recommendation to “follow patients using the same method” as at diagnosis
A significant percentage of patients with asymptomatic serologic R/POD actually have occult bone lesions	Imaging at serologic R/POD is recommended in asymptomatic patients, recommendation that departs from the current IMWG recommendation that “CT, MRI, and PET may be indicated according to clinical circumstances” at R/POD