[Perseverance]

Drop in sFLC, rise in urine M-spike

by Perseverance on Mon May 12, 2014 10:48 pm

After four years post autologous stem cell transplant (ASCT) on 5mg Revlimid maintenance , kappa free light chains have slowly risen to 43 g/dL from <10 post-transplant. The urine has slowly risen from non-existent after ASCT to about 100 mg/24 hr.

2 months ago the doctor bumped the Revlimid to 25mg and added dex. After 2 cycles, the serum kappa has dropped from 43 to 33 and the K/L ratio dropped from 8.1 to 5.4. BUT, 24 hr urine total protein went from 483 to 614 mg/24 hr, the 24 hr m-spike went from 94.7 to 143.

The thing that I noticed is that 24 hr urine creatinine and creatinine clearance were both markedly increased (3091 mg/24 and 316 mL/min respectively). These numbers are way up from from 830 mg/24hr and 80 mL/min just two months ago. Serum creatinine remains normal at 0.68.

My questions:

1) Does the urine result seem off? It just doesn't make sense to me that the serum numbers would drop but the urine would rise. I also am suspicious of the spikes in urine creatinine clearance and creatinine. Does this scenario look like a testing error anyone has seen?

2) Doctor said if we come back in a month, and the urine hasn't dropped, we will have to try a new regimen. We have no CRAB features, and our number aren't even high enough to meet the mSmart criteria for measurable disease (>200 mg/24 hr urine, >100 g/dL for the involved light chain. How could this possibly be cause for change in therapy?

[Perseverance]

Re: Drop in sFLC, rise in urine M-spike

by Perseverance on Thu May 15, 2014 12:07 pm

Any thoughts?

[GeorgeLJurak]

Re: Drop in sFLC, rise in urine M-spike

by GeorgeLJurak on Fri May 16, 2014 2:41 pm

I recommend you consult a multiple myeloma specialist in your area. It sounds to me like you just have a regular oncologist who is not familiar with multiple myeloma and the lab results. Regardless, you should always have a multiple myeloma specialist that you can consult with. If your Oncologist is a multiple myeloma expert, then I would get a second opinion. Hope all goes well. God Bless.