I was diagnosed with myeloma in July 2006 (I had just turned 31). I had an auto transplant in 2007 and another in 2011 after a decent remission. I was on Revlimid maintenance for about a year before I needed a break, so I’ve been drug free for almost two years. It looks like I’m starting to relapse yet again.
My last three blood results were 0.06 g/dL (in March), 0.11g/dL (in July) and 0.19 g/dL (in November). My oncologist wants to do a bmb in January and I’m wondering if it’s really necessary. Any thoughts? I’m really in no hurry to do this or start treatment yet again. Sigh.
Other results for November:
K/L light chain ratio, free, serum 0.66
Kappa light chain, free, serum 0.57 mg/dL
Lambda light chain, free, serum 0.865 mg/dL
Calcium measurement (calcium) 9.2 mg/dL
And in July they were:
K/L light chain ratio, free, serum 0.66
Kappa light chain, free, serum 0.671 mg/dL
Lambda light chain, free, serum 1.014 mg/dL
Calcium measurement (calcium) 9.6 mg/dL
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6 posts
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jennifrp - Name: Jen
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 2006
- Age at diagnosis: 31
Re: Bone marrow biopsy necessary now?
Those lab values do seem to be a bit on the low side for your doctor to be getting concerned. The main thing that seems to be a potential issue is the M-spike that seems to be trending upwards.
What type of myeloma do you have? I'm wondering if perhaps you have IgA myeloma and maybe your doctor is seeing changes in your IgA levels which are making him or her think that the M-spike could be changing more than what you can see in the M-spike lab results. I think M-spike readings tend to be less reliable in patients with IgA myeloma.
I guess another question is what sort of M-spike you had at diagnosis and what sort of plasma cell percentage did you have at that time? Maybe your M-spike and FLC levels don't track your disease very well, and that's why your doctor wants to do the BMB?
That's all I can think of for now. Hope it helped a bit.
What type of myeloma do you have? I'm wondering if perhaps you have IgA myeloma and maybe your doctor is seeing changes in your IgA levels which are making him or her think that the M-spike could be changing more than what you can see in the M-spike lab results. I think M-spike readings tend to be less reliable in patients with IgA myeloma.
I guess another question is what sort of M-spike you had at diagnosis and what sort of plasma cell percentage did you have at that time? Maybe your M-spike and FLC levels don't track your disease very well, and that's why your doctor wants to do the BMB?
That's all I can think of for now. Hope it helped a bit.
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Jonah
Re: Bone marrow biopsy necessary now?
Hello from Seattle jenifrp,
Your serum free light chains are not elevated at this time and the kappa/lambda ratio is normal.
When you say "my last three blood results were 0.06 g/dL (in March), 0.11 g/dL (in July) and 0.19 g/dL (in November)", I am not sure if you are referring to serum free light chain results (kappa or lambda), or serum protein electrophoresis results (SPEP).
Please clarify.
Overall, though, I agree that I do not see a strong reason for a bone marrow biopsy at this time. You do not have CRAB symptoms and these free light chain results are actually within normal limits.
Thank you.
Your serum free light chains are not elevated at this time and the kappa/lambda ratio is normal.
When you say "my last three blood results were 0.06 g/dL (in March), 0.11 g/dL (in July) and 0.19 g/dL (in November)", I am not sure if you are referring to serum free light chain results (kappa or lambda), or serum protein electrophoresis results (SPEP).
Please clarify.
Overall, though, I agree that I do not see a strong reason for a bone marrow biopsy at this time. You do not have CRAB symptoms and these free light chain results are actually within normal limits.
Thank you.
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: Bone marrow biopsy necessary now?
Dr. Libby - I apologize, those are my m-spike numbers. I'm concerned my doctor is getting too aggressive, too quickly. He mentioned starting Velcade and I'm not sure I'm ready for that. I thought the official relapse is 0.5g / dL. Is there a 'magic number' that is recommended to start treatment?
Jonah - I'm IgG but for some reason it looks like those weren't tested on my July and November blood draws. They changed labs after my March blood work and unless they're listed under something else, I don't see them. In March they measured all them with the following results:
Test Result Normal Range
Immunoglobulin G (IgG, quant) 830 mg/dL 650.0 - 1600.0
Immunoglobulin M (IgM, quant) 56 mg/dL 50.0 - 300.0
Immunoglobulin A (IgA, quant) 183 mg/dL 60.0 - 350.0
Thank you both for responding!
Jen
Jonah - I'm IgG but for some reason it looks like those weren't tested on my July and November blood draws. They changed labs after my March blood work and unless they're listed under something else, I don't see them. In March they measured all them with the following results:
Test Result Normal Range
Immunoglobulin G (IgG, quant) 830 mg/dL 650.0 - 1600.0
Immunoglobulin M (IgM, quant) 56 mg/dL 50.0 - 300.0
Immunoglobulin A (IgA, quant) 183 mg/dL 60.0 - 350.0
Thank you both for responding!
Jen
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jennifrp - Name: Jen
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 2006
- Age at diagnosis: 31
Re: Bone marrow biopsy necessary now?
There is no 'magic' number which mandates treatment. In patients who have gotten sick fast in the past (i.e., with fractures or kidney failure, etc.), doctors are often more aggressive with early therapy. Absent abnormal free light chains, renal damage is unlikely. Based on what you have posted, I would think waiting longer before biopsy, etc., seems reasonable.
Hope this was helpful.
Hope this was helpful.
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Dr. James Hoffman - Name: James E. Hoffman, M.D.
Beacon Medical Advisor
Re: Bone marrow biopsy necessary now?
Thank you! Yes, its very helpful.
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jennifrp - Name: Jen
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 2006
- Age at diagnosis: 31
6 posts
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