[sonujoshi]

How bad is it to have M-Spike level of 2.9g/dL?

by sonujoshi on Mon May 13, 2013 4:35 pm

Hello all. My mom(42) is currently being diagnosed for Multiple Myeloma. HGB and PLT counts are normal. Tough sometime PLT count goes down to 110. It's been 9 months she's on chemotherapy. She's getting 2mg Bortezomib(Velcade) along with 40mg Dexamethasone weekly and 4mg Zoledronic Acid monthly.
I made a short timeline of dignosis.

Diagnosis(25/06/2012 - 16/10/2012):
Aciclovir 400mg(B/D)
Septran(3 days a week)
Aspirin
Folvite
Autrin

25/06/2012 - 3.4g/dL
16/10/2012 - 4.3g/dL

Diagnosis(16/10/2012 - 18/03/2013):
After 16/10/2012 when they noticed M-Spike went up to 4.3g/dL they started her on Lenalidomide. After a week doctors stopped Lenalidomide because of side effects and replaced it with Thalidomide(50mg). On 18/03/2013 the M-SPike went down to 2.9g/dL and doctors increased Thalidomide to 100mg per day. The next m-spike test is scheduled on end of the month.

06/12/2012 - 3.5g/dL
18/03/2013 - 2.9g/dL

My question is, how bad is m-spike with 2.9g/dL. Is it still under control? Is the dropping rate of m-spike after getting Thalidomide(50mg) is significant? Is there something which doctors are missing in diagnosis?

[rockdoc2005]

Re: How bad is it to have M-Spike level of 2.9g/dL?

by rockdoc2005 on Mon May 13, 2013 5:44 pm

My M-spike is 1.4 and I lead a more or less normal life. It was 2.7 when I was first diagnosed in March of 2009. I took chemo for a little over a year; but have never had a stem cell transport. Suggest you continue chemo and try and reduce m-spike even more.

[Dr. Adam Cohen]

Re: How bad is it to have M-Spike level of 2.9g/dL?

by Dr. Adam Cohen on Sun May 19, 2013 10:16 pm

When we're assessing a response to therapy, it's not necessarily the absolute value of the M-spike that's important, but the % reduction from baseline. In your mom's case, she has had some response to the treatment, which is good, but the reduction has been less than 50% which is somewhat suboptimal, especially for someone her age (42), where we would typically aim to be more aggressive in getting the disease under control. Several studies have suggested that deeper responses (i.e. >90% reductions in the M-spike from baseline) are associated with longer time in remission. Every patient is different, however, and the goals of treatment need to be individualized for each patient based on how their myeloma behaves as well as their age and other medical issues. In general, however, I would agree with her doctors with regard to intensifying her therapy, either by increasing the dose or frequency of the current drugs, adding in alternative agents (e.g. cyclophosphamide), and/or considering high dose chemotherapy and autologous stem cell transplant, if she is a candidate.