[Multibilly]

Hypercalcemia levels to warrant start of treatment

by Multibilly on Sun Jul 07, 2013 9:11 am

Ever since I was diagnosed with smoldering myeloma back in November, 2012, my calcium levels have been slowly increasing. I started at 9.6 and was 10.5 on my last test (which puts me out of the normal range). My question is just what calcium level does one need to reach in order to seriously consider starting treatment? One of my docs thinks I'm about a year or so away from needing to start treatment, given how my overall numbers are trending in general.

[DMWalking]

Re: Hypercalcemia levels to warrant start of treatment

by DMWalking on Sun Jul 07, 2013 12:44 pm

That your calcium levels are increasing means that the multiple myeloma Is slowly but surely eating your bones, releasing calcium from your bones into your blood. Do you really want to wait any longer? Have you had a PET scan?

[Multibilly]

Re: Hypercalcemia levels to warrant start of treatment

by Multibilly on Sun Jul 07, 2013 3:33 pm

Thanks. I have had two skeletal xray surveys, a PET/CT scan and DEXA scan (all negative for any bone lesions and the DEXA showing a very healthy bone density) and all the usual serum and urine tests on a monthly basis. I am fully aware of what my elevating calcium levels mean (as well as all my other markers and that one doesn't just look at a single marker when making a decision to start treatment), especially if they continue to degrade.

My question was really what is usually considered in multiple myeloma circles as the threshold for one's calcium level to officially be considered hypercalcemic in terms of the CRAB criteria? After a bit more research, it looks like 11.5 mg/dL is the calcium level that the IMWG has agreed on in order for one to be classified as hypercalcemic in the context of the CRAB criteria. So, I take that as the calcium level at which most doctors would pull the trigger on starting treatment based on that one CRAB criteria?

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316455/

If my calcium level continues on its most current vector, I am indeed probably looking at about 12 months until I hit the 11.5 mg/dL level... but there is no predicting if it will accelerate, decelerate or continue its current trend over the coming months, so time will tell. And who knows what else may go south or improve marker-wise over that period of time?

[Dianem]

Re: Hypercalcemia levels to warrant start of treatment

by Dianem on Sun Jul 07, 2013 6:14 pm

Hi Multibilly - I think you mentioned of being diagnosed with low thyroid. I also have hypothyroidism along with several family members and friends. My friend had above normal calcium levels and had a complete scan (involved isotopes?) looking for bone cancers. The scans were normal, but she ended up being diagnosed with a parathyroid disorder. The parathyroid gland sits on top of the thyroid and is involved with regulating blood calcium levels. Yes, I'm aware of kidney-bone function associated with SM/multiple myeloma, but thought I'd mention the possibility of assessing parathyroid functions since they are more common with low thyroid. Diane

[Multibilly]

Re: Hypercalcemia levels to warrant start of treatment

by Multibilly on Sun Jul 07, 2013 7:29 pm

Thanks Dianem: Good to hear from you. I had all my parathyroid functions checked out some time ago (before my SMM diagnosis) and all was normal with it at that time. But I will bring the subject up when I see my oncologist in a few days to get my latest lab results.

Given I clearly have SMM, I think it is pretty clear that my increasing calcium level is simply due to my SMM since my calcium levels were just dandy before I got diagnosed with SMM in Nov '12 and my calcium level has been tracking with my slowly deteriorating M-Spike. However, I have been hypothyroid for about 20 years (again, with no calcium level issues prior to my Nov '12 SMM diagnosis).