This is a really interesting, short read on light chain escape. However, it also has a remarkable graphic in Figure 1 that shows how the clonality of one's multiple myeloma changes from the time of diagnosis to relapse.
It took me a couple of minutes to grasp the impact of Figure 1. Note that 44% of patients with FLC+Ig or Ig-only multiple myeloma switch to a different type of multiple myeloma at relapse, whether it be to FLC-only multiple myeloma, FLC+Ig multiple myeloma or Ig-only multiple myeloma!
Drayson, "Incidence of Free Light Chain Escape in Multiple Myeloma, Why is it Increasing?" (link to article)
Forums
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Change in multiple myeloma clone at relapse
Interesting, to find this report comes from my Alma Mater.
Re: Change in multiple myeloma clone at relapse
I think an important point of this article is very positive. Light chain escape (FLC only) which has a poorer prognosis, occurs in only 11 percent of subjects initially diagnosed with Ig + FLC who achieved CR and not at all in those initially diagnosed with Ig only who achieved CR.
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Anonymous
Re: Change in multiple myeloma clone at relapse
Interesting.
At diagnosis, I had IgG lambda myeloma.
My relapse was detected by increasing M-Spike (IgG), but free light chain levels have been normal since transplant. I was told they would show a relapse before, but they have remained normal.
At diagnosis, I had IgG lambda myeloma.
My relapse was detected by increasing M-Spike (IgG), but free light chain levels have been normal since transplant. I was told they would show a relapse before, but they have remained normal.
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lys2012 - Name: Alyssa
- When were you/they diagnosed?: 2010, Toronto, Canada
- Age at diagnosis: 32
Re: Change in multiple myeloma clone at relapse
Although this presentation presents the phenomena of light chain escape. Myeloma presenting as Bence Jones, FLC- no M-protein spike type, has always been considered to have a poor prognosis, largely because of affects on renal function.
Myeloma is a tricky disease indeed. We are getting more and more information on this disease but translating it into useful actions and effective individualised treatments is still mainly in the future. Each of us has different biochemistry/ physiology and reactions to the treatments and we are having to make decisions now in the hope that these buy time, with drug companies offering variations on ' an existing theme' of drug type. Some access the monoclonal antibodies through trials.
Some myeloma drugs and their 'toxicities' are now well understood as they have been around a long time. The patient and clinician now is faced with newer drugs / treatments of which they have less experience, save from the 'publications' of big pharma, early clinical trials. There are more indolent forms of myeloma and people with these do best in terms of longer term survival. Of course early detection and treatment helps..
I have noticed those with smoldering multiple myeloma at clinic who have had unusual infections are being offered trials. So the field is moving in terms of when to try and intervene. Whether a patient develops light chain escape and if particular genomes do this still needs elucidation.
Myeloma is a tricky disease indeed. We are getting more and more information on this disease but translating it into useful actions and effective individualised treatments is still mainly in the future. Each of us has different biochemistry/ physiology and reactions to the treatments and we are having to make decisions now in the hope that these buy time, with drug companies offering variations on ' an existing theme' of drug type. Some access the monoclonal antibodies through trials.
Some myeloma drugs and their 'toxicities' are now well understood as they have been around a long time. The patient and clinician now is faced with newer drugs / treatments of which they have less experience, save from the 'publications' of big pharma, early clinical trials. There are more indolent forms of myeloma and people with these do best in terms of longer term survival. Of course early detection and treatment helps..
I have noticed those with smoldering multiple myeloma at clinic who have had unusual infections are being offered trials. So the field is moving in terms of when to try and intervene. Whether a patient develops light chain escape and if particular genomes do this still needs elucidation.
Re: Change in multiple myeloma clone at relapse
My husband was diagnosed with IgG lambda multiple myeloma in 2010 and had a stem cell transplant six months later. He did not achieve complete response (CR) at 100 days post transplant but after being put on maintenance of Revlimid 15 mg and dex, he has been in complete remission for three and one-half years.
He continues to remain on maintenance of Revlimid 15 mg and dex alternating 4 mg one week and 8 mg the next week. His side effects have been manageable for the most part.
Over the last year, his kappa free light chain levels have gradually been on the rise but he has no M-spike. His latest labs showed a FLC kappa of 3.71, FLC lambda of 1.35, with a ratio of 2.75. His IgG is 745, IgA is 144 and IgM is 12. His IgM has always been low.
Neither his local oncologist or his myeloma specialist seem to know what is going on and have taken a wait and see attitude since his uninvolved FLC is the one that is on the rise. His creatinine tests are in the normal range.
Any thoughts?
He continues to remain on maintenance of Revlimid 15 mg and dex alternating 4 mg one week and 8 mg the next week. His side effects have been manageable for the most part.
Over the last year, his kappa free light chain levels have gradually been on the rise but he has no M-spike. His latest labs showed a FLC kappa of 3.71, FLC lambda of 1.35, with a ratio of 2.75. His IgG is 745, IgA is 144 and IgM is 12. His IgM has always been low.
Neither his local oncologist or his myeloma specialist seem to know what is going on and have taken a wait and see attitude since his uninvolved FLC is the one that is on the rise. His creatinine tests are in the normal range.
Any thoughts?
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anitamaria - Name: Anitamaria
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: 2010
- Age at diagnosis: 61
Re: Change in multiple myeloma clone at relapse
Hello, Anitamaria:
My non-medical opinion is as follows: 5 years (60 months) before first relapse is a very good signal for the future. Before you get to official "relapse" see what you can do to knock down the multiple myeloma burden. Speak with your multiple myeloma specialist, and based on your specific situation (including insurance issues) what is the best available treatment. For instance, if you had CyborD for initial induction, ask how you could step up the game, with a better treatment (RVD ??) see if you can get back down to CR. Treatments available today, that were not available five years ago, could potentially get you the same response, and duration of response.
However, my opinion is that you need to attack it when the multiple myeloma burden is still low, and it would not be a good thing to let that get out of hand. Good luck to you.
My non-medical opinion is as follows: 5 years (60 months) before first relapse is a very good signal for the future. Before you get to official "relapse" see what you can do to knock down the multiple myeloma burden. Speak with your multiple myeloma specialist, and based on your specific situation (including insurance issues) what is the best available treatment. For instance, if you had CyborD for initial induction, ask how you could step up the game, with a better treatment (RVD ??) see if you can get back down to CR. Treatments available today, that were not available five years ago, could potentially get you the same response, and duration of response.
However, my opinion is that you need to attack it when the multiple myeloma burden is still low, and it would not be a good thing to let that get out of hand. Good luck to you.
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JPC - Name: JPC
Re: Change in multiple myeloma clone at relapse
I have a non-medical opinion as well.
Since the FLC that is elevated is not the involved one then it could be a from of secondary MGUS although it is unusual for it to develop so long after transplant. Still, he has been on treatment with novel drugs the whole time I suppose that it is possible. If it is secondary MGUS that is a good prognostic indicator.
Also, although the kappa FLC is elevated, 3.7 is not really in the danger zone which is usually pegged at 10.
You don't mention any bone marrow biopsy or PET/CT scan results. I would look into getting both to see what is going on.
Since the FLC that is elevated is not the involved one then it could be a from of secondary MGUS although it is unusual for it to develop so long after transplant. Still, he has been on treatment with novel drugs the whole time I suppose that it is possible. If it is secondary MGUS that is a good prognostic indicator.
Also, although the kappa FLC is elevated, 3.7 is not really in the danger zone which is usually pegged at 10.
You don't mention any bone marrow biopsy or PET/CT scan results. I would look into getting both to see what is going on.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Change in multiple myeloma clone at relapse
Thanks for your input. He has not had a bone marrow biopsy since just after his stem cell transplant (going on 5 years) nor has he had a pet scan. His myeloma was initially diagnosed because of a plasmacytoma on T-12 and he has had subsequent follow-up MRI's of his spine all of which showed improvement from the initial diagnosis. I had never heard of light chain escape and am wondering why it carries a poor prognosis. It would seem that if a patient has this kind of relapse, close monitoring of renal function would detect any early problems. In any case, it seems that we need to take a much more proactive approach to find out what is going on.
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anitamaria - Name: Anitamaria
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: 2010
- Age at diagnosis: 61
Re: Change in multiple myeloma clone at relapse
Not to belabor the possibility of a possible light chain escape relapse with my husband's myeloma, but given that his kappa free light chain level has been on the rise for about a year (his free light chain at diagnosis was lambda) and since impaired renal function is a characteristic of this type of relapse, wouldn't he have had some test results to reflect that by now? So far all of his kidney/renal function tests have been in the normal range.
This type of relapse is just so hard to figure out (if that is what he has) and I'm a bit surprised that neither his multiple myeloma specialist or his local oncologist have been more assertive in trying to get to the bottom of it.
This type of relapse is just so hard to figure out (if that is what he has) and I'm a bit surprised that neither his multiple myeloma specialist or his local oncologist have been more assertive in trying to get to the bottom of it.
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anitamaria - Name: Anitamaria
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: 2010
- Age at diagnosis: 61
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