Started off with M spike over 8.
After one cycle of RVD, no M spike detected.
Categorized as "standard myeloma" with 2.2% plasma.
Does this sound more like "high risk" behavior? Does anyone have experience or knowledge of how high risk myeloma reacts to initial treatment?
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Re: Questioning initial high risk multiple myeloma diagnosis
Hi hopeful27,
What was the basis of the myeloma being diagnosed as "high risk"? The IMWG definitions for high risk, standard risk, and low risk are described in this Beacon news article,
Experts Publish Consensus Risk Classification For Multiple Myeloma
The classification depends on the stage of the myeloma (based on the ISS), the patient's age, and -- most importantly -- the presence or absence of certain chromosomal abnormalities.
The Mayo Clinic uses a slightly different risk classification system, as explained here:
http://msmart.org/newly%20diagnosed%20myeloma.pdf
(The recent changes in the Mayo system and guidelines are discussed in this forum thread, which includes commentary from the Beacon's myeloma specialist columnist Dr. Vincent Rajkumar.)
More specifically to your question, there is evidence from a study presented last year that high-risk multiple myeloma can respond either very quickly to treatment, or very slowly. This was pointed out by Beacon forum member Mark in this recent forum posting, in which he points to a relevant abstract presented at last year's ASCO meeting.
The citation and abstract are below. Note, in particular, the first part of the Conclusions: "Both shallow and very deep response to therapy in cycle 1 is a strong indicator of eventual disease outcome and should be considered as marker of high-risk disease".
Krishna Bilas Ghimire et al, "Implications of rapidity of response to initial therapy in multiple myeloma". J Clin Oncol 31, 2013 (suppl; abstr 8606)
Abstract:
Background: The rapidity of response to initial therapy in multiple myeloma (multiple myeloma) depends on a variety of factors. There is limited data on its implications on long term outcomes in patients (pts) with newly diagnosed multiple myeloma. Methods: We retrospectively examined the outcomes in a cohort of 454 pts with newly diagnosed multiple myeloma between Jan 2000- Dec 2011 undergoing induction therapy.
Results: The median age at diagnosis was 66 yrs (29-92). Pts had measurable serum M-spike (>= 1 g/dL), dFLC (>=10 mg/dl) or 24 hour urinary M protein excretion (UrM; >=200 mg) in 70, 63 and 39% respectively. We first examined the relationship between the response to first cycle of therapy and overall survival (OS). We divided pts into quartiles based on their % reduction in the serum M spike, dFLC or UrM. The median OS (Table) was poorest for pts with the least reduction of serum M protein (P<0.001) and of dFLC. The cutoffs for Q1 was 25, 40 and 40% decrease for serum M spike, dFLC and 24 hr UrM respectively. Among various baseline characteristics only higher age was predictive of a poor (Q1) response. Given the trend toward worse OS among the Q 4 group (maximum decrease in serum M spike), we examined the relationship to cytogenetic risk. Among 232 pts with FISH data available, proportion of pts with high-risk disease was 27, 12, 22 and 31% respectively in quartiles 1 - 4). In a multivariate analysis, quartile 1 and 4 of serum M-protein response and the high-risk FISH were independent risk factors associated inferior OS.
Conclusions: Both shallow and very deep response to therapy in cycle 1 is a strong indicator of eventual disease outcome and should be considered as marker of high-risk disease, likely through different mechanisms. For the shallow responders, prospective trials should assess if a change in therapeutic management will alter the outcome of these pts. The rapid deep responders also appear represent a different high-risk biology, emphasizing the fact that pts with high-risk disease often have excellent initial responses, but poor long term outcomes.
[see link below for related table]
http://meetinglibrary.asco.org/content/118060-132
What was the basis of the myeloma being diagnosed as "high risk"? The IMWG definitions for high risk, standard risk, and low risk are described in this Beacon news article,
Experts Publish Consensus Risk Classification For Multiple Myeloma
The classification depends on the stage of the myeloma (based on the ISS), the patient's age, and -- most importantly -- the presence or absence of certain chromosomal abnormalities.
The Mayo Clinic uses a slightly different risk classification system, as explained here:
http://msmart.org/newly%20diagnosed%20myeloma.pdf
(The recent changes in the Mayo system and guidelines are discussed in this forum thread, which includes commentary from the Beacon's myeloma specialist columnist Dr. Vincent Rajkumar.)
More specifically to your question, there is evidence from a study presented last year that high-risk multiple myeloma can respond either very quickly to treatment, or very slowly. This was pointed out by Beacon forum member Mark in this recent forum posting, in which he points to a relevant abstract presented at last year's ASCO meeting.
The citation and abstract are below. Note, in particular, the first part of the Conclusions: "Both shallow and very deep response to therapy in cycle 1 is a strong indicator of eventual disease outcome and should be considered as marker of high-risk disease".
Krishna Bilas Ghimire et al, "Implications of rapidity of response to initial therapy in multiple myeloma". J Clin Oncol 31, 2013 (suppl; abstr 8606)
Abstract:
Background: The rapidity of response to initial therapy in multiple myeloma (multiple myeloma) depends on a variety of factors. There is limited data on its implications on long term outcomes in patients (pts) with newly diagnosed multiple myeloma. Methods: We retrospectively examined the outcomes in a cohort of 454 pts with newly diagnosed multiple myeloma between Jan 2000- Dec 2011 undergoing induction therapy.
Results: The median age at diagnosis was 66 yrs (29-92). Pts had measurable serum M-spike (>= 1 g/dL), dFLC (>=10 mg/dl) or 24 hour urinary M protein excretion (UrM; >=200 mg) in 70, 63 and 39% respectively. We first examined the relationship between the response to first cycle of therapy and overall survival (OS). We divided pts into quartiles based on their % reduction in the serum M spike, dFLC or UrM. The median OS (Table) was poorest for pts with the least reduction of serum M protein (P<0.001) and of dFLC. The cutoffs for Q1 was 25, 40 and 40% decrease for serum M spike, dFLC and 24 hr UrM respectively. Among various baseline characteristics only higher age was predictive of a poor (Q1) response. Given the trend toward worse OS among the Q 4 group (maximum decrease in serum M spike), we examined the relationship to cytogenetic risk. Among 232 pts with FISH data available, proportion of pts with high-risk disease was 27, 12, 22 and 31% respectively in quartiles 1 - 4). In a multivariate analysis, quartile 1 and 4 of serum M-protein response and the high-risk FISH were independent risk factors associated inferior OS.
Conclusions: Both shallow and very deep response to therapy in cycle 1 is a strong indicator of eventual disease outcome and should be considered as marker of high-risk disease, likely through different mechanisms. For the shallow responders, prospective trials should assess if a change in therapeutic management will alter the outcome of these pts. The rapid deep responders also appear represent a different high-risk biology, emphasizing the fact that pts with high-risk disease often have excellent initial responses, but poor long term outcomes.
[see link below for related table]
http://meetinglibrary.asco.org/content/118060-132
Re: Questioning initial high risk multiple myeloma diagnosis
At initial diagnosis her doctor said it was quote "very, very aggressive".
After her FISH came back it said it was "standard", with normal cytogenetics and no chromosome abnormalities.
After one cycle of RVD it basically put her into some sort of remission, showing no signs in either blood or urine. Is this a normal response?
After her FISH came back it said it was "standard", with normal cytogenetics and no chromosome abnormalities.
After one cycle of RVD it basically put her into some sort of remission, showing no signs in either blood or urine. Is this a normal response?
Re: Questioning initial high risk multiple myeloma diagnosis
Were the FISH results you mentioned after her first month of treatment, or at diagnosis?
5 posts
• Page 1 of 1