[timsdawn]

Do these lab results indicate relapse is occurring?

by timsdawn on Fri May 23, 2014 10:03 am

Hi all,.

My husband was diagnosed March 2013 with IgG lambda multiple myeloma.

At diagnosis:

WBC/ANC - 3.0/1.4
Hgb/HCT - 7.8/24.0
Platelets - 149
BUN/Creat - 12/1.04
Ca - 9.0
M-spike - 3.6
IgG - 5155
IgA - 23
IgM - 6
SFL Kappa - .508
SFL Lambda - 321.5
SFL ratio - <0.01
B2M - 3.2
% plasma cells - 95%
CYTO - ABN
FISH - ABN

By that time, and in the following months, he had heavy bone involvement -- ribs, sternum, spine -- and had an intrathecal pain pump implanted May 2013. (Regular pain meds brought out the effects of his stroke in 2010, speech and cognition; there is no way we could have gone through the last year without the pain pump!) Kidney function has been great.

He underwent several cycles of RVD [Revlimid, Velcade, and dexamethasone], followed by an auto stem cell transplant August 30, 2013. (Though when they found he still had 80% plasma cells in his marrow, down from 95% at time of diagnosis, they hit him with Cytoxan [cyclophosphamide] prior to transplant.)

100 days post transplant, (12-19-13) he still had:
10% plasma cells
M-spike - 0.53
IgG - 995
IgA - 26
IgM - <20
SFL Kappa - .34
SFL Lambda - 12.30
SFL ratio - 0.03
CYTO - Normal
FISH - ABN

At the beginning of this year, he started treatments with Kyprolis (carfilzomib), with dex (8mg) on treatment days (2 days a week for 3 weeks, then 4th week off).

180 day results: (March 17, 2014)
1% plasma cells
M-spike - 0.33
IgG - 795
IgA - 26
IgM - <20
SFL Kappa - 1.07
SFL Lambda - 5.64
SFL ratio - 0.19

Now we get to the reason for my post.

Results of May 12, 2014 after 4 cycles of Kyprolis-dex (labs drawn just prior to start of cycle 5)
(no bone marrow biopsy done... just blood work):

M-spike - 0.3
IgG - 789
IgA - 35
IgM - 24
SFL Kappa - 0.7
SFL Lambda - 11.36
SFL ratio - .06

Seeing these results instantly brought up 2 questions:

Is the rising lambda number (and falling ratio) indicative of anything (relapse)?
Should we be expecting better treatment results -- all key numbers falling rather than seeming to level out or go up?

I know this is a long post, and I apologize for that, but part of the reason for the questions is that the numbers were getting 'better', but now appear to be going the other way.

His oncologist is fantastic, and we trust him. He has not hesitated in the past to consult with Tim's multiple myeloma specialist, and we think it may be time to do that again? She is the one who recommended this treatment. We should find out if the results are within what was expected??

Any info/insight/suggestions -- anything -- would be greatly appreciated!!!

His oncologist's present opinion is to not worry too much about the lambda numbers and wait to see if there is a trend.

I can understand that, but with the other numbers remaining pretty much stable, and with us being told that Tim has an aggressive and resistant form of myeloma, how long can we afford to wait?

Would asking for a bone marrow biopsy be out of the question?

Thank you so much.
Dawn

[Ron Harvot]

Re: Do these lab results indicate relapse is occurring?

by Ron Harvot on Fri May 23, 2014 11:02 am

I believe you are right on target with your thinking and anaysis. They probably need to re-run the tests but based on things so far, it would appear that some adjustment to his treatment is probably necessary.

The good news is that there are pleanty of options out there. For example they may just add Revlimid to the mix or may try some other drugs.

Good Luck

Ron

[Ron Harvot]

Re: Do these lab results indicate relapse is occurring?

by Ron Harvot on Fri May 23, 2014 11:29 am

The sFLC often shows trends before they are picked up by the other blood tests such as the SPEP which lags a little.

[Dr. Jatin Shah]

Re: Do these lab results indicate relapse is occurring?

by Dr. Jatin Shah on Mon May 26, 2014 11:39 pm

That level of lambda free light chain changes is not worrisome. As you alluded to, there are multiple ways to follow myeloma, and sometime there will be confusing trends in opposite directions. In this case, the change is small and in the normal range.

[timsdawn]

Re: Do these lab results indicate relapse is occurring?

by timsdawn on Wed May 28, 2014 8:39 pm

Thank you both for your responses!

We met with Tim's oncologist today, and we did get some reassurances. Tim's 'numbers' are still definitely less than 10% of what they were at the time of diagnosis, so he is, technically, in VGPR.

Tomorrow, he finishes cycle 5 of carfilzomib [Kyprolis] / dex. One more cycle of 2 days a week for 3 weeks, and the doc will order the myeloma marker labs again mid-cycle. The plan, in late March, was for 3 more cycles at the current setup, then switch to something less frequent as a maintenance regimen.

We are grateful for every day, and grateful to be, finally, getting into a routine that does not involve emergency hospital stays. *smile* I tend to do my job better if I have as much info as possible. It helps me to get through if I can avoid surprises as much as possible.

We will try to just find that balance, again, between vigilance, acceptance, determination, and, yes, relaxation. *smile*

A huge thank you to everyone on this site! You are all amazing and your input is priceless! Thank you!