[rumnting]

Is he relapsing?

by rumnting on Sat Feb 09, 2013 11:39 am

My husband had his auto transplant in October of 2011. For the last year his M-spike has stayed stable at 0.3. In October he was taken off Revlimid and Dex, and his Velcade reduced to every other week. In November his M-spike was 0.1. December 0.2 January 0.3 Feb. 0.5. His other labs (hemoglobin and gamma globulins (?)) are stable.
Is this rising M-Spike most likely relapse, or variations caused by stopping the Rev. and Dex?

[Dr. Adam Cohen]

Re: Is he relapsing?

by Dr. Adam Cohen on Sat Feb 09, 2013 10:48 pm

The official IMWG (International Myeloma Working Group) definition of progression (or relapse) is a >25% rise in the M-spike from the lowest level, with a minimum absolute increase of 0.5, confirmed on repeat testing. So if his M-spike hit 0.6 on 2 consecutive measurements, it technically would be called a relapse. However, it's important to remember that treatment decisions shouldn't necessarily be based on numbers alone - the whole clinical picture has to be taken into account, including whether there is concern for any end-organ damage from the myeloma and what the potential toxicities of additional treatment would be. Often low level M-spikes can fluctuate like this for some time before additional treatment is truly needed - this is something to discuss futher with his oncologist. Hope this is helpful.