[Jessica]

Biclonal Myeloma after transplant

by Jessica on Fri Jul 06, 2012 5:25 pm

Good Afternoon,
I am writing to see if anyone has had a similar expierence. I had a stem cell transplant over 7 months ago. Prior to transplant I had an m-spike of 0.3, since transplant my m-spike has dropped to 0.2 and remained at 0.2 for the past 7 months. I have just received my latest lab results and noticed that my m-spike is still at 0.2 but I now have a double m-spike. The other m-spike is reported at 0.2 as well. The Immunofixation test states a IgG Kappa biclonal gammopathy. I have noticed the biclonal refernce in the past 2 tests but paid no attention to it until I saw the double m-spike. I am confused. On my 6 month mark I had a bone marrow biopsy which reported 0 plasma cells. I was looking forward to having sometime without having to take chemo. Has anyone had a similar expierence following transplant? If so, could you please share your expierence. I am very concerned that I will have to start treatment again.

Thank you.

[Dr. Adam Cohen]

Re: Biclonal Myeloma after transplant

by Dr. Adam Cohen on Sun Jul 08, 2012 9:46 pm

There is a phenomenon called "oligoclonal reconstitution" that can occur after transplant, where new M-spikes can transiently emerge as the immune system recovers and starts to make antibodies again. It usually is not a reflection of the myeloma starting to grow again; in fact some studies have suggested that patients who develop oligoclonal reconstitution may have longer remissions post-transplant, though this is not definitively proven. The extra clones usually disappear by a year post-SCT, and no specific intervention other than continued surveillance is required.

[Jessica]

Re: Biclonal Myeloma after transplant

by Jessica on Tue Jul 10, 2012 10:36 am

Really Dr. Cohen!! I have an appointment next week with my doctor to discuss. I was so worried. I am having a difficult time with maintenance so the thought of going on full dose chemotherapy would be devastating.

Thank you for the information and for responding!! I hope I have a long time before needing full blown treatment.

[Stann]

Second M spike

by Stann on Wed Jul 11, 2012 4:46 pm

My current blood results says "IGG/lambda still present"...I've been seeing that on the report for almost 3 years now. But now it says "second faint IGG kappa spike present in the beta region". it goes on to say it could be inflammation...but I've heard that one before.
Anyway, I'm assuming this is not good news. My Mspike (lambda) has been low and stable since finishing tandem in sept 2011 so I have been pretty happy.
Assuming this is not just inflammation, (I just did another blood draw to confirm), would this be considered a second case of multiple myeloma? Would it be categorized as a secondary cancer?
I'm feeling fine...just a little shaken today.
I had a BMB that went really, really well this morning. Easier than having a cavity filled. But getting these results afterwards has left me a little numb.
My doctor appointment is not for another 3 weeks, so any input would be welcome.

[Stann]

Re: Second M spike

by Stann on Wed Jul 11, 2012 6:53 pm

Wow. Am I happy to read this!! Ribeye steaks tonight!

"The emergence of oligoclonal bands is associated with a favorable outcome after autologous stem cell transplantation in multiple myeloma"
Conclusion
Small APB are very frequent post-transplant for myeloma, and IEF can identify these APB as oligoclonal or monoclonal. Apparent monoclonal bands may represent relapsed disease, but in the vast majority of cases it does not, and most likely represents a transient phenomenon representing regeneration of a limited immune response.

I sure hope I'm interpreting this correctly.

[Stann]

Re: Biclonal Myeloma after transplant

by Stann on Wed Jul 11, 2012 9:33 pm

Hi Jessica, this is so weird... I just found your post. I posted the same concern earlier today. I'm 11 months post sct and just found a second spike--this morning I assumed the worst. I've been visiting this site off and on for a few years and don't recall seeing this discussed. And now we post same concern within a day of each other.
I'm glad it appears to be of no big concern. Or possibly a good sign?
I think I'll buy a lotto ticket tonight!

[Eric Hofacket]

Re: Biclonal Myeloma after transplant

by Eric Hofacket on Wed Jul 11, 2012 10:51 pm

The first time I heard of the phenomena that Dr. Cohen is talking about was in an article posted to this web site in the last two months I believe. If you search you may be able to find it. I also remember as Dr. Cohen mentioned that in the article they stated that in their study there appeared no evidence that developing a Biclonal or Triclonal ( some got three spikes) post SCT was any kind of prognostic indicator for a negative outcome, if fact there was some evidence it might be a positive indicator. I think it is important that when you obtain lab results before seeing them with your doctor not to panic. The internet makes this kind of information available to us quickly but I really believe a doctor is needed to explain the context of lab results and what they mean for the patients specific case. I hear cases of patients getting lab results before seeing their doctor and getting anxiety over nothing. I am sure the reverse happens a lot too and the doctor may see things that we do not see in our labs.

[stann]

Re: Biclonal Myeloma after transplant

by stann on Thu Jul 12, 2012 11:15 am

Hi Eric,
Thanks for your reply. I could not find that article in the Beacon you referenced. But I did find the information via other articles.
I agree with you to not get overly concerned about lab results. But after 3 years of devoting my life (literally) to hammering down an Mspike, to see a brand new one was very alarming. I still don't understand why a new clone could be good, but I'll take it. Thanks.