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Elevated ALP level - what does it mean?
My husband has developed an elevated ALP level. Anyone with this and what has your doctor said?
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dogmom - Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 58
Re: Elevated ALP level - what does it mean?
My doc told me not to worry about my only slightly elevated ALP.
I'm not a doc, but a high ALP level can suggest several different liver issues and/or bone fractures and/or skeletal breakdown or lytic lesions caused by multiple myeloma. It's a good thing to discuss with your doctor, especially if any bone loss and/or lytic lesions are in play and the ALP level is especially high. I take it that your husband is getting routinely imaged and is having DEXA scans performed from time to time?
To double check liver function in general, you would also look at the AST and ALT levels that you already get as part of his ongoing comprehensive metabolic tests.
I'm not a doc, but a high ALP level can suggest several different liver issues and/or bone fractures and/or skeletal breakdown or lytic lesions caused by multiple myeloma. It's a good thing to discuss with your doctor, especially if any bone loss and/or lytic lesions are in play and the ALP level is especially high. I take it that your husband is getting routinely imaged and is having DEXA scans performed from time to time?
To double check liver function in general, you would also look at the AST and ALT levels that you already get as part of his ongoing comprehensive metabolic tests.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Elevated ALP level - what does it mean?
Multibilly,
All the rest of his liver function labs are normal – AST, ALT, TBILI, etc, in fact, they are on the lower normal range. He did have full skeletal films done on diagnosis a month ago and all it showed was a healed compression fracture of the spine. The rest of it looked good according to our myeloma onc. He was having rib pain on diagnosis but during this first cycle of chemo it has much improved.
Could the elevated ALP be due to the bones recovering from myeloma effects? I do know ALP can be elevated due to fracture and/or bone healing, but his is over 400 and that is pretty elevated. It can be elevated due to just bone and or cancer in the bones as well.
All the rest of his labs are SO much better now, this elevation just concerned me. We meet with the doc next Thursday for evaluation after the first cycle and I will ask him.
All the rest of his liver function labs are normal – AST, ALT, TBILI, etc, in fact, they are on the lower normal range. He did have full skeletal films done on diagnosis a month ago and all it showed was a healed compression fracture of the spine. The rest of it looked good according to our myeloma onc. He was having rib pain on diagnosis but during this first cycle of chemo it has much improved.
Could the elevated ALP be due to the bones recovering from myeloma effects? I do know ALP can be elevated due to fracture and/or bone healing, but his is over 400 and that is pretty elevated. It can be elevated due to just bone and or cancer in the bones as well.
All the rest of his labs are SO much better now, this elevation just concerned me. We meet with the doc next Thursday for evaluation after the first cycle and I will ask him.
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dogmom - Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 58
Re: Elevated ALP level - what does it mean?
I think it's probably best to discuss this with your onc as I don't know any more than what I would simply find by googling the topic. I also just realized I was mistaken and that my ALP is actually just a tad low at 34 IU/L (with a normal range of 39-117 IU/L).
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Elevated ALP level - what does it mean?
I was interested in this posting because my ALP has been elevated for about the past 6 months. Now it is about 130. Other liver functions are normal. I was diagnosed in April 2014, did induction with Revlimid, Velcade, and dexamethasone (RVD) followed by an autologous stem cell transplant in October 2014. Currently on Velcade / dex maintenance, bi-weekly. In stringent complete remission (sCR).
I brought up the elevated ALP issue with my oncologist. He said that it can increase with treatment. However, since I am on LESS treatment than I used to be, it doesn't seem to correlate, but perhaps it is cumulative treatment that affects the ALP. He also said not to worry about it and it is generally not investigated until / unless the ALP reaches 170 - 180.
I have had gallbladder issues in the past ... never had it removed. It is "sluggish." I have also had GERD for years and irritable bowel, too. My onc said that sometimes the ALP can become elevated when there is a stone in the gallbladder.
I guess it is one of those medical mysteries. If the ALP goes up or I have suspicious symptoms, I guess I will have to find out what it may be. I am hoping it is just one of those test results that remains idiopathic.
I brought up the elevated ALP issue with my oncologist. He said that it can increase with treatment. However, since I am on LESS treatment than I used to be, it doesn't seem to correlate, but perhaps it is cumulative treatment that affects the ALP. He also said not to worry about it and it is generally not investigated until / unless the ALP reaches 170 - 180.
I have had gallbladder issues in the past ... never had it removed. It is "sluggish." I have also had GERD for years and irritable bowel, too. My onc said that sometimes the ALP can become elevated when there is a stone in the gallbladder.
I guess it is one of those medical mysteries. If the ALP goes up or I have suspicious symptoms, I guess I will have to find out what it may be. I am hoping it is just one of those test results that remains idiopathic.
Re: Elevated ALP level - what does it mean?
Hi dogmom,
Shortly after starting treatment and radiation, my husband was hospitalized with a bile duct stricture, which may have been caused by a stone, but it had passed by the time he got to the hospital. Both his ALP and bilirubin were elevated (ALP over 600), however, and he had extreme nausea and GI issues. It resolved itself and hasn't recurred.
Shortly after starting treatment and radiation, my husband was hospitalized with a bile duct stricture, which may have been caused by a stone, but it had passed by the time he got to the hospital. Both his ALP and bilirubin were elevated (ALP over 600), however, and he had extreme nausea and GI issues. It resolved itself and hasn't recurred.
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lwem - Name: Laurie
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 68
Re: Elevated ALP level - what does it mean?
My husband's is over 400 and all the rest of his liver function tests are lower range normal and he has no symptoms of any kind of issue related to liver or gallbladder other than the elevated ALP.
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dogmom - Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 58
Re: Elevated ALP level - what does it mean?
I have done some searching and when I googled the topic elevated ALP with Velcade treatment, I found several studies suggesting that an elevated ALP with no other liver values elevated was associated with a good response to treatment. I am hoping his elevated ALP is good sign. 
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dogmom - Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 58
Re: Elevated ALP level - what does it mean?
Hi dogmom,
Thanks for digging deeper into this. You're right. There have been several studies looking at the increase in ALP after treatment with Velcade (and Kyprolis), and they indicate that an increase is associated with a good response.
Since it might be helpful for others, I thought I'd list here a few of the relevant studies on the subject:
M Zangari et al, "Predictive value of alkaline phosphatase for response and time to progression in bortezomib-treated multiple myeloma patients", American Journal of Hematology, Sep 2007 (abstract)
M Zangari et al, "Alkaline phosphatase variation during carfilzomib treatment is associated with best response in multiple myeloma patients," European Journal of Haematology, Jun 2011 (abstract)
"Serum ALP elevation early after treatment is a predictor for response in myeloma patients treated with bortezomib" (English translation of Japanese title), Rinsho Ketsueki, Aug 2015
(English translation of abstract, full text in Japanese [PDF])
Here's a quote from the abstract of the first article, reporting findings similar to those reported in the other articles:
Thanks for digging deeper into this. You're right. There have been several studies looking at the increase in ALP after treatment with Velcade (and Kyprolis), and they indicate that an increase is associated with a good response.
Since it might be helpful for others, I thought I'd list here a few of the relevant studies on the subject:
M Zangari et al, "Predictive value of alkaline phosphatase for response and time to progression in bortezomib-treated multiple myeloma patients", American Journal of Hematology, Sep 2007 (abstract)
M Zangari et al, "Alkaline phosphatase variation during carfilzomib treatment is associated with best response in multiple myeloma patients," European Journal of Haematology, Jun 2011 (abstract)
"Serum ALP elevation early after treatment is a predictor for response in myeloma patients treated with bortezomib" (English translation of Japanese title), Rinsho Ketsueki, Aug 2015
(English translation of abstract, full text in Japanese [PDF])
Here's a quote from the abstract of the first article, reporting findings similar to those reported in the other articles:
For all bortezomib-treated patients enrolled in the trial (N = 333), at least a 25% increase in ALP from the baseline at 6 week was the most powerful predictor of treatment response (P < 0.0001) and time to progression (206 vs. 169 days) relative to patients with less than a 25% increase in ALP (P = 0.01).
Re: Elevated ALP level - what does it mean?
Yes, Cheryl, these are some of the articles I found as well. I so hope this is the case with my husband. All of his other liver enzymes being normal (lower end of normal) lends itself to being more hopeful as this is the case.
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dogmom - Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 58
10 posts
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