Hi.
My husband was diagnosed early last year with stage 3 high risk multiple myeloma. He was able to achieve partial remission from a stem cell transplant, but he relapsed in July and the myeloma is now attacking his brain and spinal cord, which is very rare. He responded well to radiation, but isn't tolerating Pomalyst at all. They've taken him off of all treatment so that he can hopefully stop throwing up and gain some strength.
His most recent blood test shows his free kappa is 973.3 and his kappa lambda ratio is 82.48. These numbers have drastically increased from his last blood work and are well above the normal range. What does it mean and is there a sense of urgency to begin treatment even if he's not tolerating it?
At this time his prognosis is 6 months, but he's 47 so we think additional treatment might be a try.
Thanks and sorry for such a long post.
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lyndaks8 - Name: Lynda Stewart
- Who do you know with myeloma?: My husband
- When were you/they diagnosed?: 02/2015
- Age at diagnosis: 46
Re: High kappa-lambda ratio during treatment pause
His light chain numbers are high as is the ratio but others have had much higher numbers. Is he seeing a myeloma specialist? There are a number of new drugs that he could try with Darzalex in combination with either Revlimid or Velcade plus dexamethasone showing very good results.
That may be an option you could explore with his oncologist.
Good luck to you both.
That may be an option you could explore with his oncologist.
Good luck to you both.
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: High kappa-lambda ratio during treatment pause
Yes, he's seeing a myeloma specialist. He was on VRD before his transplant and on Revlimid as maintenance so that's not an option this time around.
I just wasn't sure if the high numbers meant the cancer was growing rapidly or if it's possibly the amount of cancer in his body or if it's nothing too alarming. His doctor is often vague with his explanations. I suspect he doesn't want to be the bearer of bad news.
Thanks for your response, Ron.
I just wasn't sure if the high numbers meant the cancer was growing rapidly or if it's possibly the amount of cancer in his body or if it's nothing too alarming. His doctor is often vague with his explanations. I suspect he doesn't want to be the bearer of bad news.
Thanks for your response, Ron.
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lyndaks8 - Name: Lynda Stewart
- Who do you know with myeloma?: My husband
- When were you/they diagnosed?: 02/2015
- Age at diagnosis: 46
Re: High kappa-lambda ratio during treatment pause
Hi Lynda,
Welcome to the forum. I am sorry to hear that your husband's myeloma has spread and that he is not responding to Pomalyst. Is he also being tracked for the monoclonal protein? Unless he is a 'nonsecretor' for the protein, it would also be used to determine whether or not a treatment was working.
Has your doctor suggested other treatments, either funded where you live, or by clinical trial? Besides the immunomodulatory agents such as Revlimid and Pomalyst, and the proteasome inhibitors such as Velcade, there are other types of treatments, such as those that attack monoclonal antibodies – for example Darzalex (daratumumab). Drugs that have the suffix 'mab' attack cancer cells with antibodies on the outer cell wall. There are also treatments that are similar to the melphalan used in stem cell transplants, the alkylating agents. I think that Cytoxan (cyclophosphamide) falls into this category.
Good luck and I hope that you can get this situation turned around. Please ask at the forum for any questions, since there are many knowledgeable people posting here.
Welcome to the forum. I am sorry to hear that your husband's myeloma has spread and that he is not responding to Pomalyst. Is he also being tracked for the monoclonal protein? Unless he is a 'nonsecretor' for the protein, it would also be used to determine whether or not a treatment was working.
Has your doctor suggested other treatments, either funded where you live, or by clinical trial? Besides the immunomodulatory agents such as Revlimid and Pomalyst, and the proteasome inhibitors such as Velcade, there are other types of treatments, such as those that attack monoclonal antibodies – for example Darzalex (daratumumab). Drugs that have the suffix 'mab' attack cancer cells with antibodies on the outer cell wall. There are also treatments that are similar to the melphalan used in stem cell transplants, the alkylating agents. I think that Cytoxan (cyclophosphamide) falls into this category.
Good luck and I hope that you can get this situation turned around. Please ask at the forum for any questions, since there are many knowledgeable people posting here.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: High kappa-lambda ratio during treatment pause
Just a quick clarification to prevent possible confusion:
Drugs with "mab" at the end of their generic name, such as daratumumab and elotuzumab, are monoclonal antibodies. That's what the "mab" stands for. They are not called "monoclonal antibodies" because of what they attack, but because of what they are – exact replicas (clones) of a single kind of antibody.
The monoclonal antibodies used in the treatment do not attack monoclonal antibodies. They are designed to attack cells that have specific molecules found on the surfaces of cells. In the case of daratumumab, the target molecule is CD38, which is a type of enzyme found on the surface of many kinds of immune cells, including plasma cells.
Monoclonal antibodies are used for other purposes in addition to the treatment of myeloma and other cancers. There are monoclonal antibodies used to treat autoimmune diseases such as Crohn's disease and asthma, and to prevent blood clots in certain situations.
Drugs with "mab" at the end of their generic name, such as daratumumab and elotuzumab, are monoclonal antibodies. That's what the "mab" stands for. They are not called "monoclonal antibodies" because of what they attack, but because of what they are – exact replicas (clones) of a single kind of antibody.
The monoclonal antibodies used in the treatment do not attack monoclonal antibodies. They are designed to attack cells that have specific molecules found on the surfaces of cells. In the case of daratumumab, the target molecule is CD38, which is a type of enzyme found on the surface of many kinds of immune cells, including plasma cells.
Monoclonal antibodies are used for other purposes in addition to the treatment of myeloma and other cancers. There are monoclonal antibodies used to treat autoimmune diseases such as Crohn's disease and asthma, and to prevent blood clots in certain situations.
Re: High kappa-lambda ratio during treatment pause
Thanks Terry H for the clarification. The 'mab' drugs are interesting! Also, I used the term 'outer cell wall', which I realized later is a term used to describe the cell walls of eukaryotic bacteria! Blood cells and plasma cells have a membrane type of covering ll I think. I wanted to tell Lynda that there are several categories of treatments that are used for myeloma.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: High kappa-lambda ratio during treatment pause
Lynda,
Here is a link in the Beacon to the recent FDA approval for using Darzalex in combination with either Velcade or Revlimid. Darzalex works better when combined with one of these drugs even if a patient is refractory to one or both.
https://myelomabeacon.org/pr/2016/11/21/fda-approves-darzalex-revlimid-velcade-dexamethasone-relapsed-multiple-myeloma/
Here is a link in the Beacon to the recent FDA approval for using Darzalex in combination with either Velcade or Revlimid. Darzalex works better when combined with one of these drugs even if a patient is refractory to one or both.
https://myelomabeacon.org/pr/2016/11/21/fda-approves-darzalex-revlimid-velcade-dexamethasone-relapsed-multiple-myeloma/
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: High kappa-lambda ratio during treatment pause
Nancy,
I agree that Lynda's husband certainly has a number of treatment options still.
But, again to make sure there is no confusing information here, bacteria are prokaryotes (i.e., they don't have nuclei). It's a contradiction to write "eukaryotic bacteria", as bacteria are not eukaryotic.
Perhaps you meant to say "gram-negative bacteria", since such bacteria have an outer membrane similar to what you possibly were thinking of when you made your post earlier in this thread.
I agree that Lynda's husband certainly has a number of treatment options still.
But, again to make sure there is no confusing information here, bacteria are prokaryotes (i.e., they don't have nuclei). It's a contradiction to write "eukaryotic bacteria", as bacteria are not eukaryotic.
Perhaps you meant to say "gram-negative bacteria", since such bacteria have an outer membrane similar to what you possibly were thinking of when you made your post earlier in this thread.
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