[CindyBrown]

Kappa free light chains rising prior to SCT - is that ok?

by CindyBrown on Tue Sep 23, 2014 3:19 pm

I am leaving in a week to start my stem cell transplant process at SCCA [Seattle Cancer Care Alliance].

While my bone marrow biopsy (BMB) shows a drop in my plasma cell percentage from 80% to 4%, my light chains from last week have increased yet again. The lowest for my kappa free light chains was in the 1100 range and now they are a little over 1500.

My local oncologist does not seem overly concerned, but I don't understand why this increase is not of concern. Can anyone shed some light? I have been following the light chain discussions for a while.

Thanks!

[Multibilly]

Re: Kappa free light chains rising prior to SCT - is that ok

by Multibilly on Tue Sep 23, 2014 4:15 pm

CindyBrown,

To be clear, is your concern that you are proceeding into the transplant without having your kappa free light chains under control, and in fact having them on the rise?

As a help to others responding to this thread, I quickly scanned your other posts. It looks like you also have amyloidosis without cardiac involvement and are kappa light chain-restricted with no M-spike, right?

You went through a few cycles of Rd that was responsible for your bone marrow plasma cell percentage dropping from 80% to 4%.

One generally wants to have as a deep a response as possible prior to beginning the HD-ASCT, but I will leave it to others to comment given your specific circumstances.

Last edited by Multibilly on Wed Sep 24, 2014 8:45 am, edited 1 time in total.

[Dr. Adam Cohen]

Re: Kappa free light chains rising prior to SCT - is that ok

by Dr. Adam Cohen on Wed Sep 24, 2014 8:39 am

While it is true that we like to have good disease control going into stem cell collection and transplant, there is not a specific light chain level that would preclude moving forward. It is really a judgment call on the part of the transplant physician on whether to proceed as planned or try additional induction therapy, and this should be discussed with your physician as an individualized decision.

It's not uncommon for levels to rise slightly during time off therapy while stem cell collection is undertaken. As long as the plan is to move promptly to stem cell transplant, the high dose chemotherapy given before stem cell reinfusion will treat the rising light chains, and there can always be additional consolidation and maintenance therapy given after transplant if there is still residual disease remaining.

I hope this is helpful.