I have a question regarding kappa light chain numbers and stem cell transplantation (SCT). I have IgA multiple myeloma diagnosed back in 2008. I have been on various chemo's up to this point. Most recently I was involved in a clinical trial with pomalidomide [Pomalyst, Imnovid]. It worked well. Not quite in remission.
Due to financial and time constraints, I'm contemplating a SCT at the end of this month. I know that having the least amount of circulating cancer cells prior to the SCT seems to provide the best outcome. My current kappa light chains are 150, with a B2 of 1.18. Bone marrow biopsy this past August, 6 showed 8% plasma cell involvement. All other labs are labs are good.
Given these light chain numbers do not reflect complete remission, would it still be prudent to go ahead with the transplant? Thanks!
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Re: Kappa light chains and SCT
Are the units that your light chain numbers read out in mg/dL or mg/L? If mg/L, 150 is not that high. Regardless of the units, you do not need to be in a complete remission to enjoy clinical benefit from a transplant. Based on the other information you have provided, it looks like you are in a good place. As such, if your treating physician feels that now is an appropriate time, I would support that approach.
Best of luck to you and let us know how things go!
Pete V.
Best of luck to you and let us know how things go!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Kappa light chains and SCT
Dr. Voorhees, thanks for the reply and support . The light chain measurements are in mg/L.
One other issue. What does the term light chain escape mean?
My physician uses that term to describe why I've recently had a drastic increase in bone involvement -- lesions, pathologic fractures, etc., even though my light chains have not really changed that much over time. They have always been in the low hundreds while on chemo; my B2's and LDs have always been normal as well, although I've never been in CR.
For the first two years of my diagnosis I really did not have any bone involvement whatsoever. Per my bone marrow biopsies, I have have no chromosomal abnormalities. Not sure I'm grasping the theory.
Thanks in advance for your response.
One other issue. What does the term light chain escape mean?
My physician uses that term to describe why I've recently had a drastic increase in bone involvement -- lesions, pathologic fractures, etc., even though my light chains have not really changed that much over time. They have always been in the low hundreds while on chemo; my B2's and LDs have always been normal as well, although I've never been in CR.
For the first two years of my diagnosis I really did not have any bone involvement whatsoever. Per my bone marrow biopsies, I have have no chromosomal abnormalities. Not sure I'm grasping the theory.
Thanks in advance for your response.
Re: Kappa light chains and SCT
Light chain escape refers to a phenomenon when the myeloma no longer makes an intact antibody (consisting of a heavy and light chain) and produces only the light chain component of the antibody.
If you are following myeloma response / progression by SPEPs alone (which is good at measuring intact myeloma antibodies, but not free light chain antibodies), you can miss this, which is why many of us incorporate serum free light chain testing into our testing.
In your case, if your light chains have increased in the face of new bone lesions, free light chain escape is an accurate descriptor of what is happening. If you are experiencing lots of new bone complications with no change in any of your myeloma numbers, including light chains, it could mean that the myeloma cells that remain are making less intact antibodies (heavy and light chains), so the myeloma numbers are not necessarily accurately reflecting what is going on with your myeloma.
If this is the case, you may need to rely more heavily on additional means to monitor the disease (imaging -- for example, PET/CT -- bone marrow biopsies, etc).
If the only new bone complications you have suffered are vertebral body compression fractures, that does not necessarily mean that the disease has progressed. If the bone is weakened by myeloma, It is not unusual for patients to suffer vertebral fractures even in the absence of disease progression.
On the other hand, new bone lesions or growth of existing lesions is typically indicative of disease progression.
I hope this helps. Take care and good luck!
Pete V.
If you are following myeloma response / progression by SPEPs alone (which is good at measuring intact myeloma antibodies, but not free light chain antibodies), you can miss this, which is why many of us incorporate serum free light chain testing into our testing.
In your case, if your light chains have increased in the face of new bone lesions, free light chain escape is an accurate descriptor of what is happening. If you are experiencing lots of new bone complications with no change in any of your myeloma numbers, including light chains, it could mean that the myeloma cells that remain are making less intact antibodies (heavy and light chains), so the myeloma numbers are not necessarily accurately reflecting what is going on with your myeloma.
If this is the case, you may need to rely more heavily on additional means to monitor the disease (imaging -- for example, PET/CT -- bone marrow biopsies, etc).
If the only new bone complications you have suffered are vertebral body compression fractures, that does not necessarily mean that the disease has progressed. If the bone is weakened by myeloma, It is not unusual for patients to suffer vertebral fractures even in the absence of disease progression.
On the other hand, new bone lesions or growth of existing lesions is typically indicative of disease progression.
I hope this helps. Take care and good luck!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
4 posts
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