My husband was diagnosed with IgA kappa type multiple myeloma. I hear it may be harder to treat, M-spike numbers are less reliable, etc.
Can people chime in on key things to know about IgA kappa multiple myeloma?
Thank you.
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Re: IgA kappa multiple myeloma - what to know?
Irankin, I am IgA kappa and started treatment in August 2014. I started with Revlimid (25 mg) and dexamethasone (40 mg once a week). This brought me to near complete response. Then Velcade injections were added and I quickly achieved a complete response. I have the t(4;14) abnormality for which Velcade seems to be rather important. I continue to get a Velcade injection once every two weeks and a Zometa infusion once every three months as my maintenance. Adverse side effects have not actually posed much of a problem for me except for a severe cough induced by the Revlimid.
I have a blood test (CBC) right before each Velcade injection and a full work up each month. All the test results are important, but the ones that I consider most important, as far as the myeloma goes, are the immunofixation and the free light chains and kappa/lambda ratio. My oncologist has told me, as evidently yours told you, that the M-spike is not necessarily the most useful indicator for IgA patients. Nevertheless, I am very glad each month to learn that the SPEP continues to show no M-spike. I know that this will change some day. I think that more significant than the IgA category for purposes of treatment is the kind of chromosomal mutations, if any, your husband may have.
I have a blood test (CBC) right before each Velcade injection and a full work up each month. All the test results are important, but the ones that I consider most important, as far as the myeloma goes, are the immunofixation and the free light chains and kappa/lambda ratio. My oncologist has told me, as evidently yours told you, that the M-spike is not necessarily the most useful indicator for IgA patients. Nevertheless, I am very glad each month to learn that the SPEP continues to show no M-spike. I know that this will change some day. I think that more significant than the IgA category for purposes of treatment is the kind of chromosomal mutations, if any, your husband may have.
Re: IgA kappa multiple myeloma - what to know?
Thank you, mrozdav. I am glad you are responding so well to treatment.
Actually, no doctor – hem/onc, multiple myeloma specialist, or stem cell transplant (SCT) doctor – has told us M-spike is not the best indicator for IgA kappa. I learned this from reading this forum.
My husband, 48, has had Revlimid, Velcade, and dex (RVD) treatment and an auto SCT. He does not currently have any of the chromosomal abnormalities.
We will find out the details of his response to the SCT today. I will be drilling the multiple myeloma specialist on IgA kappa and why no one would point out this M-spike nuance.
Thank you, again, for your response and wishing you all the best.
Actually, no doctor – hem/onc, multiple myeloma specialist, or stem cell transplant (SCT) doctor – has told us M-spike is not the best indicator for IgA kappa. I learned this from reading this forum.
My husband, 48, has had Revlimid, Velcade, and dex (RVD) treatment and an auto SCT. He does not currently have any of the chromosomal abnormalities.
We will find out the details of his response to the SCT today. I will be drilling the multiple myeloma specialist on IgA kappa and why no one would point out this M-spike nuance.
Thank you, again, for your response and wishing you all the best.
Re: IgA kappa multiple myeloma - what to know?
Irankin,
The difficulty with monitoring IgA M-spikes is that other proteins can show up in the same area of the SPEP graph where the IgA M-spike normally lives. This can in turn give a patient the wrong value for an IgA M-spike. However, I believe that if one has an IgA M-spike of zero (like Mrozdav), then that value would be trustworthy. But any IgA M-spike value above zero can be suspect for the reasons I cited above (but you should check this with your doc).
IgA patients therefore monitor their progress through their free light chains and immunofixation (as Mrozdav mentions) and through their quantified IgA (aka total IgA, which is the sum of both the monoclonal and normal IgA levels in one's blood).
There is also a newer test known as the HevyLite test (which is now available through Quest and Labcorp in the USA), that is very good for tracking treatment response in IgA patients.
Regarding the risk associated with IgA-type multiple myeloma, you may want to read through this thread (especially Dr. Landau's comments):
https://myelomabeacon.org/forum/is-iga-multiple-myeloma-aggressive-t3855.html
The difficulty with monitoring IgA M-spikes is that other proteins can show up in the same area of the SPEP graph where the IgA M-spike normally lives. This can in turn give a patient the wrong value for an IgA M-spike. However, I believe that if one has an IgA M-spike of zero (like Mrozdav), then that value would be trustworthy. But any IgA M-spike value above zero can be suspect for the reasons I cited above (but you should check this with your doc).
IgA patients therefore monitor their progress through their free light chains and immunofixation (as Mrozdav mentions) and through their quantified IgA (aka total IgA, which is the sum of both the monoclonal and normal IgA levels in one's blood).
There is also a newer test known as the HevyLite test (which is now available through Quest and Labcorp in the USA), that is very good for tracking treatment response in IgA patients.
Regarding the risk associated with IgA-type multiple myeloma, you may want to read through this thread (especially Dr. Landau's comments):
https://myelomabeacon.org/forum/is-iga-multiple-myeloma-aggressive-t3855.html
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: IgA kappa multiple myeloma - what to know?
Thank you all for your responses. Very helpful.
My husband's post autologous stem cell transplant (ASCT) results show MRD - and his kappa / lambda ratio's normal and IgA, IgM, IgG are normal. Yet, there is a 0.1 g/dL M-spike. So, what you shared about the M-spike for IgA could apply here.
Will look into that Hevylite test. Thank you, again!
My husband's post autologous stem cell transplant (ASCT) results show MRD - and his kappa / lambda ratio's normal and IgA, IgM, IgG are normal. Yet, there is a 0.1 g/dL M-spike. So, what you shared about the M-spike for IgA could apply here.
Will look into that Hevylite test. Thank you, again!
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