[Jafe]

I need help Understanding my lab work

by Jafe on Fri Mar 15, 2013 11:23 pm

I am 53 years old, i was diagnosed with Multiple Myeloma on August 15 2011 when i suffered a pathological fracture of my left Hip. (BMB showed 60% Myeloma Cell, Kappa Off the charts and G over 9000)
For the pass two years i have been under different Doctors and treatments, at first i took 6 months of CyBorD (Cyclophosphamide, bortezomib and dexamethasone) Then i went for a Total hip replacement on march 2012, followed by 6 cycles of Revlimid (25mg) with Velcade twice a week, weekly Dexa (40mg) and monthly Zometa.
After having an excellent response to the treatment, Last Oct 30, 2012, I went for a auto SCT, oh Boy!!! That was a bad experience, after developing a bacterial infection of the Blood (E. Coli ). After 21 days in the hospital and 35 pound lighter, finally, i was able to go home on November 22, 2012. Just to find my self back in the hospital on Dec 12, 2012 with the same bacterial infection in the blood. The bacteria had managed to survive in my Hip's prosthesis. On Dec 24, i was operated on my Hip to cleaned, I am back home now on Lovenox and Rifampin, and it look like i will have to take this Combo of antibiotics for a long time.
Nevertheless, i had a BMB on march 5, and here are the result.

Spe IF M: IgG Kappa 0.8 g/dl
UPEP IF IgG Kappa 9.5mg/24Hr
Quant. Immuno-globulin A 32, M 24.7, G 1770
Kappa Lambda Ratio : K 1.65, L 1.18, R 1.4
BM bx: Atypical Plasma Cell Infiltrate (5%) Kappa Restricted
BM Aspirate: Mild atypical plasmacytosis is present compromising 7% of all nucleated elements.
Cytogenetics: Normal, No fish
Hemoglo 10.9
Platelet 213
White blood 6.2 anc 2.98
Albumin 4.4
Creatine : 0.71
Calciun 9.2

I am Now on Revlimid maintenance (10Mg) with Monthly Zometa.
After all, I consider my self Lucky to be here, Moving, Walking and energetic. Thank God.
Can some one tell me in simple words, what is the good and bad from my numbers?
Thanks
God Bless.

[terryl1]

Re: I need help Understanding my lab work

by terryl1 on Sat Mar 16, 2013 8:48 am

Hi Jose, what jumped out at me is the fact that you and I were diagnosed within a few days of each other in 2011 at about the same age. Where are you being treated? I am in the midst of a clinical trail which used carfilzomib for newly diagnosed and am now on low dose Revlimid like you. So far, so good and, like you, I am lucky to be here.

Hopefully, one of the doctors will comment on your case. It seems like you currently have more than residual disease based on the BM results and other markers outlined. Hopefully, the maintenance can chop this down. Also, you are anemic at 10.9. For a guy your age, it should be, depending on your lab's reference range, close to 14.0 or so. Your kidney function, based solely on the creatinine, is good. Did you have a PET CT recently? That would be important to show if there are areas of increased uptake, lesions, etc. in your bones/marrow as compared to your baseline PET CT. Good luck with everything!

[Jafe]

Re: I need help Understanding my lab work

by Jafe on Sat Mar 16, 2013 10:11 am

Hi Terry.
Thanks for your reply. Wow, I also think is amazing we share almost the same age and date of diagnosis.
I am currently taking treatments at NewYork-Presbyterian Cancer center. I think the Doctors and Staff are superb, Just that sometimes i have so many questions about this decease.
I was going crazy as to why after 120 days post SCT i am still anemic, it is so hard for me to get that number up to normal range, i eat all nutritional food and nothing, Vitamin, you name it. that number just simply is crawling up. thank for clarifying that to me.

I am Getting a PET done this month on the 25, i will let you know, but this is from my previous PET. did not demonstrate abnormal FDG-uptake.
PET CT PELVIS:
Lymph nodes: There is no pathologically enlarged lymph node.
Soft tissue: Normal.
Vascular structures: The imaged vascular systems are grossly
normal.
Other observations: None.

I never heard before about carfilzomib, how is it? any side effect?
Thanks Terry. I hope everything continues to be excellent for you.
will keep in touch.

[terryl1]

Re: I need help Understanding my lab work

by terryl1 on Sat Mar 16, 2013 1:54 pm

Hi Jose, sounds like you are in the right place for treatment. I started treatment in April, 2012, at the NIH (the NCI) part near Washington, DC. They have a clinical trial utilzing carfilzomib/Revlimid and dex for newly diagnosed. I had 8 cycles of this combo and at the end of December, 2012, I went on maintenance with 10 mg. Revlimid. Carfilzomib for me is and was experimental but thankfully it was approved last year for relapsed patients. I had my stem cells harvested for a rainy day. One point of the trial is to see if the duration of the response is equal to or better than the tradition induction and then SCT. Only time will tell but I was happy to try this. Several posters on this site are in my trial or a similar one.

Hopefully, with time your RBC and hemoglobin will come back. When I started my trial, my hemoglobin was 8.8 and this Tuesday is was 16.5. It took about 10 or 11 months to reach this point. Good luck! Un abrazo fuerte.

[Dr. Peter Voorhees]

Re: I need help Understanding my lab work

by Dr. Peter Voorhees on Mon Mar 18, 2013 12:23 am

The results would best be interpreted in the context of the baseline results before you started any treatment. You still have an M-spike of 0.8 g/dL and 5-7% myeloma cells (kappa restricted plasma cells) in your marrow. This burden of disease is quite low and could certainly continue to decline on Revlimid maintenance therapy. Whether you are in a partial remission (50 - 90% decrease in your M-spike) or very good partial remission (>90% decrease in your M-spike) depends on the original M-spike levels.

The anemia is likely a consequence of prior therapy and should get better over the ensuing months. Your other parameters look great. I am glad you are doing better. Take care!

Pete V.