[Lev]

Test results during CyBorD treatment - some questions

by Lev on Sun Oct 12, 2014 8:23 pm

I am left with a few questions. And although my experience is that you should usually ask one question at a time, I will take those that have to do with blood tests and results together here

After being diagnosed with multiple myeloma in Juni 2014 the hospital planned initial treatment with 3x3 or 3x4 cycles of cyclophosphamide / Velcade / dexamethasone (CyBorD / VCD) followed by stem cell harvest and ASCT.

After first initial cycle and blood tests they decided that 3 cycles of the initial treatment would be enough.

But I am a little bit uncertain because they did not take any blood test after the third/final cycle of the initial treatment.

First, some results, then my questions.

BMB in June showed 15% plasma cells.

M-Spike Results

Jun 11: 22.7 g/L (2.27 g/dL)
Jul 10: 12.5 g/L (1.25 g/dL)
Aug 6: 8.3 g/L (0.83 g/dL)

Aug 8: Treatment started with the first of 3 cycles of CyBorD.

Aug 26: 3.0 g/L (0.30 g/dL) (after the cycle of CyBorD).
Sep 17: 1.4 g/L (0.14 g/dL) (after the second cycle of CyBorD).

Then I got the last cycle of CyBorD - ending 2 weeks ago.

No new blood test before starting high level chemo on October 23 followed by stem cell harvest on November 4th and planned ASCT in December.

Question 1: Is it “normal” not to take a blood test after the last cycle, thereby not getting to know if the values kept falling and the result after the last treatment? Would the result of the blood test and M-spike after the final third series be important for decisions about the next step or in any other way?

Question 2: Is the drop from 22.7 to 1.4 a good result (they say so, but when I tried to get the threshold they were going for, I got evasive answers)?

Question 3: Is it “normal” for the M-spike to drop from 22.7 to 8.3 even before starting the treatment?

Free Light Chain Test Results

Kappa/Lambda Ratio (newest test first)
Normal area should be 0.31 - 1.56

Sep 17 0.51
Aug 26 0.47
Aug 15 0.61
Aug 6 1.77
Jul 10 3.00
Jun 11 4.06

Kappa Free Light Chains (IgG) (newest value first)
Normal area should be 6.7 - 22.4

Sep 17 16.1
Aug 26 16.7
Aug 15 19.9
Aug 6 90.1
Jul 10 129.0
Jun 11 192.0

Lambda Free Light Chains (IgG) (newest value first)
Normal area should be 8.3 - 27.0

Sep 17 31.7
Aug 26 35.2
Aug 15 32.8
Aug 6 51.0
Jul 10 43.0
Jun 11 47.3

Question 4: Are the results here OK? What can we learn from the kappa free light chains, lambda free light chains, and the kappa/lambda ratio?

Lots of greetings to everybody here.

P.S. - 57 year old, Caucasian male. No problems with kidneys, no calcium in the blood, no bone fractures. One area in the third hip bone and one area in the shoulder is lightning up on the x-ray.

[Dr. James Hoffman]

Re: Test results during CyBorD treatment - some questions

by Dr. James Hoffman on Tue Oct 14, 2014 11:01 am

1. It is routine to get those labs after every cycle. In this case, it probably would change nothing practically, but it is nice to have the most current results as a baseline to compare going forward.

3. Yes, you had a >90% drop in the M-spike, which constitutes a very good partial response (VGPR). This is a desired outcome.

3. It is unusual for markers to drop in this way before therapy. I would not be surprised if early in your course you received some steroids (e.g. prednisone or dexamethasone). Often these are given before formal treatment, and could have resulted in the improvement.

4. You had kappa disease, so the kappa was elevated relative to the lambda. Hence the elevated kappa/lambda ratio initially. With therapy, this ratio normalized. Myeloma cells often secrete an intact antibody (measured by the M-spike and immunoglobulin levels) as well as abnormal antibody 'light chains.' When that is the case, both have to be measured to assess response / relapse, etc.

Hope this clarifies things! Good luck going forward.

[Lev]

Re: Test results during CyBorD treatment - some questions

by Lev on Tue Oct 14, 2014 5:19 pm

Thanks to Dr. James Hoffman for the answers and comments.

Just one thing to add here. You write: "It is unusual for markers to drop in this way before therapy. I would not be surprised if early in your course you received some steroids (e.g. prednisone or dexamethasone). Often these are given before formal treatment, and could have resulted in the improvement."

And I am wondering to, and the physicians here as well. And, no, I did not receive any treatment before August 8th.

No dexamethasone or prednisone before that.

Best regards