[GLCarlton]

What kappa level will say it's time to change treatment?

by GLCarlton on Fri May 27, 2016 3:57 pm

I have a question about my lab results, what seems to be trending and what may lie ahead.

First off, I am 64 years old, was working as an SLP until diagnosed 2 years ago with stage III multiple myeloma. Looking back to before the diagnosis, I was showing pretty classic symptoms (compression fractures in lumbar / thoracic vertebrae, pain in ribs and sternum), but these were not noted as significant by my PCP. I have a history of back issues, and I wrote off the chest pains as muscle pain from my attempts to compensate for back pain by using my arms/chest more for getting out of chair etc.

A bone marrow biopsy confirmed the diagnosis of multiple myeloma , and I was assigned one of the oncologists at the regional cancer center by the discharge planner at the hospital. Care has been very good.

At that time, I was started on Velcade (injection in the abdomen), Revlimid (15 mg 21 days on / 7 days off) and 20 mg of dexamethasone 1x/week, and Zometa 1x/3 months). Velcade was discontinued after 8 cycles as the labs were showing normal results essentially. I was placed on maintenance therapy consisting of Revlimid and dexamethasone at the mentioned dosages.

My question: I noticed that my kappa light chains as well as the kappa/lambda ratio were starting to elevate slightly, approaching the high end of normal, and slightly increasing on each follow up visit. All other lab results were normal with the exception of some areas seen as side effects of chemo.

Currently kappa light chains exceed the upper limits of the normal range (4.48), and are at the baseline level when treatment was initiated (September 2014). Electrophoresis results show normal findings (except for kappa light chain). There is no M-spike, and beta-2 microglobulin is well within normal range. My oncologist offered to increase Revlimid from 15 mg to 25 mg, but felt it was unnecessary.

I do not feel any worse now than a year ago. Fatigue from the Revlimid and “withdrawals” from the weekly dex are problematic at times, but there is no pain. Bowel and bladder are behaving. Would this be considered a typical pattern?

How much of an increase in the kappa light chain can we expect before a possible change in treatment is warranted? Are there symptomatic changes that would alert me to significant changes in the disease process?

Thanks, GC

[Janet1520]

Re: What kappa level will say it's time to change treatment?

by Janet1520 on Sat May 28, 2016 12:32 pm

I believe my doctor said they could let them go up to 20 before changing treatment. My kappa light chains were 104 at diagnosis.

[Ron Harvot]

Re: What kappa level will say it's time to change treatment?

by Ron Harvot on Sat May 28, 2016 7:06 pm

Mine have been trending up very slowly over the past 9 months. My kappa light chain is currently around 80 and the ratio is 12.9. However, my M-spike has remained at 0.2 g/dL (2 g/L) and actually dropped from 0.3 6 months ago. Everything else remains good. Normal kidney function, normal hemoglobin, calcium, etc.

I have been on Velcade and dex, with a shot of Velcade every 2 weeks. The only thing that has changed is an increase in the dex form 8 mg to 40 mg once every 2 weeks. This has slowed the progress but not stopped it. So my oncologist will likely change the medication in August the next time we run the serum free light chain (sFLC) test. I feel no fatigue or pain. We talked about adding in 5 mg of Revlimid and see what that does, but since it is so slow there has not been a rush on his or my part to change things right now.