[Arizonan]

Emergence of M spike 3 years later

by Arizonan on Fri May 03, 2013 2:58 pm

Three years ago I was diagnosed with multiple myeloma.  My kappa light chains were 700, but no M spike.  After an autologous transplant my KLCs went down to around 10.  During two and a half years of Velcade-Dex maintenance my KLCs stayed around 10 with no M spike.  

Ten weeks ago I ended the maintenance.  My KLCs remain around 10, but in the last six weeks an M-spike emerged, first at .1mg/dL, now at .2 g/dL

I hope someone can help me understand this latest development.

Thanks

David

[KFJ]

Re: Emergence of M spike 3 years later

by KFJ on Fri May 03, 2013 3:43 pm

You may now be dealing with a new clone. In other words, it may be that your disease is evolving . . . Did you have cytogenetics carried out at diagnosis and in the recent past, as the results may bear on the issue.

[Arizonan]

Re: Emergence of M spike 3 years later

by Arizonan on Fri May 03, 2013 7:20 pm

Thanks KFJ

I had a BMB at diagnosis 3 yrs ago, which indicated CD2. My annual BMBs since then haven't produced any results, possible because there wasn't enough disease. It sounds like I need to get another BMB to see if it is a clone.

I'm not sure if these other parts of the lab results mitigate the emergence of an M spike:

Serum Protein Electrophoresis:
Total M Component .2 g/dL
A band of restricted mobility between the beta and gamma positions.
There is hypogammaglobulinemia.
The beta globulin is decreased.

Serum Immunoelectrophoresis:
Immunofixation demonstrates no monoclonal protein.

Thanks
David

[Dr. Ken Shain]

Re: Emergence of M spike 3 years later

by Dr. Ken Shain on Sun May 05, 2013 6:20 pm

I am sorry to say, but It sounds as though you may have serologic relapse of disease. I would recommend that you consider restaging with repeat marrow, imaging and the like.

It is not common, but a a good percentage of patients will relapse with changes in their disease with the emergence of slightly different presentation (or stated below a different clone). Typically, it happens with something called light chain escape. Patient who initially had both heavy and light chain- then relapsed with light chain only. The reverse can happen as well-I have patients that were non-secretory and relapse with secretory disease.

Please keep us updated.

[Arizonan]

Re: Emergence of M spike 3 years later

by Arizonan on Mon May 06, 2013 12:14 am

Thanks for your reply.

Is relapse likely when the Immunoelectrophoresis showed no monoclonal protein?

David

[Dr. Ken Shain]

Re: Emergence of M spike 3 years later

by Dr. Ken Shain on Mon May 06, 2013 6:42 am

can there be relapse in the absence of a clonal paraprotein? yes.
In your initial post you stated you had an M-spiked 0.2 (monoclonal paraprotein) on SPEP, correct?
That is serum protein electrophoresis.

[Arizonan]

Re: Emergence of M spike 3 years later

by Arizonan on Mon May 06, 2013 12:53 pm

Dr. Shain,

Thank you for your help.

David