My husband was diagnosed almost four years ago with Stage 3 IgG lambda multiple myeloma. He received Revlimid, Velcade, and dexamethasone (RVD) induction therapy, and then a stem cell transplant in August 2016. His M-spike prior to his transplant did not go below 1.0 g/dL (10 g/l). It got to 0.8 g/dL post-transplant.
After his transplant, he received 4 months of Kyprolis, Revlimid, and dexamethasone (KRD) consolidation therapy, followed by maintenance therapy with Revlimid 10 mg with no breaks. By May of 2017 his M-spike was no detectable.
Then in March 2019 an M-spike was detected but not enough to quantify. In June 2019, his M-spike was 0.4 g/dL. His doctors added dex to his maintenance therapy and increased the dose of Revlimid. There was co change; his M-spike kept rising. By September 2019 it was up to 0.9 g/dL.
At that point, he was started on Darzalex and Pomalyst with dex for 2 days post Darzalex infusion.
His labs were drawn before his 4th infusion of Darzalex, and they now showing not only the IgG lambda, but now a free monoclonal protein of kappa?
I have never have seen this before. I know one study said Darzalex can sometimes affect the uninvolved heavy chains (Beacon article about the study), but how about the uninvolved light chain?
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DaleJC28117 - Name: Dale
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: 2016
- Age at diagnosis: 57
Re: Monoclonal kappa light chain after Darzalex treatment?
Hi Dale,
What exactly did the serum immunofixation, serum electrophoresis, and serum free light chain assays report?
It would be expected that an IgG kappa M-spike would show up in the test results since Darzalex is itself a monoclonal IgG kappa antibody. Note that there is a new test called a Hydrashift assay that can eliminate those false IgG kappa M-spike readings due to Darzalex.
However, Darzalex should not interfere with serum free light chain assay levels (i.e. it should not impact either monoclonal or polyclonal free light chain levels). See this article for more on that topic:
http://www.wikilite.com/monitoring-patients-treated-with-mabs
What exactly did the serum immunofixation, serum electrophoresis, and serum free light chain assays report?
It would be expected that an IgG kappa M-spike would show up in the test results since Darzalex is itself a monoclonal IgG kappa antibody. Note that there is a new test called a Hydrashift assay that can eliminate those false IgG kappa M-spike readings due to Darzalex.
However, Darzalex should not interfere with serum free light chain assay levels (i.e. it should not impact either monoclonal or polyclonal free light chain levels). See this article for more on that topic:
http://www.wikilite.com/monitoring-patients-treated-with-mabs
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Monoclonal kappa light chain after Darzalex treatment?
Hello Dale and Multibilly,
Thank you for explaining this. I have had four treatment sessions with Darzalex over the past three weeks, I also take dexamethasone capsules at home on the days following my hospital infusions and Velcade injections at home on various days between the Darzalex sessions. These are provided by a home visiting specialist nurse. I would like to share with you my early responses.
Even after the first Darzalex treatment, I noticed an immediate improvement in my physical symptoms and well-being. As compared with the previous Pomalyst (pomalidomide, Imnovid) regimen, my energy level is better, and my movement (walking, bending, etc) is easier. I have received my blood test results which are as follows;
Electrophoresis (October 21, 2019) - 11.1% 7.2 g/L (0.72 g/dL)
Electrophoresis (November 11, 2019) - 8.4% 5.4 g/L (0.54 g/dL)
The first figures are without the benefit of Darzalex.
The second electrophoresis has the comment of a new peak which I presume is similar to what Multibilly has discussed:
"Presence of 2 IgG Kappa Peaks"
I repeat, it is very early days and I await with impatience the December results.
Best Regards from Victor L
Thank you for explaining this. I have had four treatment sessions with Darzalex over the past three weeks, I also take dexamethasone capsules at home on the days following my hospital infusions and Velcade injections at home on various days between the Darzalex sessions. These are provided by a home visiting specialist nurse. I would like to share with you my early responses.
Even after the first Darzalex treatment, I noticed an immediate improvement in my physical symptoms and well-being. As compared with the previous Pomalyst (pomalidomide, Imnovid) regimen, my energy level is better, and my movement (walking, bending, etc) is easier. I have received my blood test results which are as follows;
Electrophoresis (October 21, 2019) - 11.1% 7.2 g/L (0.72 g/dL)
Electrophoresis (November 11, 2019) - 8.4% 5.4 g/L (0.54 g/dL)
The first figures are without the benefit of Darzalex.
The second electrophoresis has the comment of a new peak which I presume is similar to what Multibilly has discussed:
"Presence of 2 IgG Kappa Peaks"
I repeat, it is very early days and I await with impatience the December results.
Best Regards from Victor L
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Victor L - Name: Victor L
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2012
- Age at diagnosis: 58
Re: Monoclonal kappa light chain after Darzalex treatment?
Thanks for the information, and what a relief. It stated on the immunofixation electrophoresis (IFE) “suspected monoclonal kappa free band." I was worried that his IgG lambda was getting a new player on the field.
No one told us the Darzalex could cause this and they would need a different assay to get his M-spike. He gets his sixth infusion on Thursday. His ANC was low last week at 0.6, but criteria only calls for a hold if 0.5 and lower. He restarts his Pomalyst tonight. See what the week brings.
Thanks for all the helpful and rapid responses. You all are my heroes!
No one told us the Darzalex could cause this and they would need a different assay to get his M-spike. He gets his sixth infusion on Thursday. His ANC was low last week at 0.6, but criteria only calls for a hold if 0.5 and lower. He restarts his Pomalyst tonight. See what the week brings.
Thanks for all the helpful and rapid responses. You all are my heroes!
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DaleJC28117 - Name: Dale
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: 2016
- Age at diagnosis: 57
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