I was reading on another post that, before a stem cell transplant or maintenance, light chain numbers should be below 100. Is this true?
Generally speaking, how many rounds of chemo (Velcade, Revlimid & Dex) would be required to achieve these results?
If you've been told you have reached a VGPR, should chemo be continued to get a deeper response?
I'm interested in hearing other's experiences.
This sure is confusing!
Thank you,
Kim
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Jerseygyrl - Name: Kim
- Who do you know with myeloma?: My Loved One
- When were you/they diagnosed?: February 2014
- Age at diagnosis: 58
Re: Do light chain levels need to be below 100 before a SCT?
Jerseygyrl,
I had an autologous transplant back in November that was originally scheduled for September. It was postponed because the transplant doctor wanted my numbers to be lower prior to collection of the stem cells for fear that the collection would pull in some of the unwanted free light chains. At the time the postponement occurred my numbers had stalled at around 10. At that point, 25mg Revlimid was added to my Velcade/dex regimen. This brought my numbers down to 5 at which point he gave the go ahead. Ideally he would've liked to have seen normal numbers before proceeding.
I have no idea if the required numbers are different depending on the type of transplant being performed.
Rick
I had an autologous transplant back in November that was originally scheduled for September. It was postponed because the transplant doctor wanted my numbers to be lower prior to collection of the stem cells for fear that the collection would pull in some of the unwanted free light chains. At the time the postponement occurred my numbers had stalled at around 10. At that point, 25mg Revlimid was added to my Velcade/dex regimen. This brought my numbers down to 5 at which point he gave the go ahead. Ideally he would've liked to have seen normal numbers before proceeding.
I have no idea if the required numbers are different depending on the type of transplant being performed.
Rick
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Blackbird - Name: Rick Crow
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Feb, 2013
- Age at diagnosis: 53
Re: Do light chain levels need to be below 100 before a SCT?
Thank you for your response Rick 
I apologize, I should've been more specific. Yes, I am referring to an autologus SCT & to someone who has been diagnosed with kappa light chain myeloma.
I also remember reading somewhere that the kappa to lambda ratio comes into play as well. Is this correct ? If is is, what is the "magic" number doctors are looking for to make you an ideal candidate for a successful ASCT?
All of this is making my head spin!!
I apologize, I should've been more specific. Yes, I am referring to an autologus SCT & to someone who has been diagnosed with kappa light chain myeloma.
I also remember reading somewhere that the kappa to lambda ratio comes into play as well. Is this correct ? If is is, what is the "magic" number doctors are looking for to make you an ideal candidate for a successful ASCT?
All of this is making my head spin!!
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Jerseygyrl - Name: Kim
- Who do you know with myeloma?: My Loved One
- When were you/they diagnosed?: February 2014
- Age at diagnosis: 58
Re: Do light chain levels need to be below 100 before a SCT?
I, in fact, have kappa light chain myeloma, also. Mine is what is referred to as, I believe, non-secretary, or something like that, meaning my M-spike was almost non-existent. As such, my bones have not been affected and my primary concern is my kidney function (as well as other organs if it goes unchecked).
At any rate, to try to answer your question, as the free light chain number drops, the ratio should approach normal (which floats around 1). Like I said, ideally the doctor would've have liked to have seen me in remission (all numbers normal) prior to the transplant, but that didn't happen. So, my guess is that your target would be to get as close to that as possible prior to the SCT.
Will they do the transplant if he stalls at 100 and nothing can get it lower? I have no idea. Perhaps someone else can answer that question.
At any rate, to try to answer your question, as the free light chain number drops, the ratio should approach normal (which floats around 1). Like I said, ideally the doctor would've have liked to have seen me in remission (all numbers normal) prior to the transplant, but that didn't happen. So, my guess is that your target would be to get as close to that as possible prior to the SCT.
Will they do the transplant if he stalls at 100 and nothing can get it lower? I have no idea. Perhaps someone else can answer that question.
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Blackbird - Name: Rick Crow
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Feb, 2013
- Age at diagnosis: 53
Re: Do light chain levels need to be below 100 before a SCT?
I just had a consult at Fred Hutchinson where I will go for my stem cell transplant and the doctor there said light chains need to be "normal" for SCT. My local doctor did not check them after I finished my first full course of VRD so he will check after 2nd course. They want me to start SCT immediacy upon normalization of light chains.
I had 80% plasma cells at diagnosis and lesions everywhere including the sacral tumor which is the reason the diagnosis was found
I had 80% plasma cells at diagnosis and lesions everywhere including the sacral tumor which is the reason the diagnosis was found
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CindyBrown - Name: Cindy Brown
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 4/26/14
- Age at diagnosis: 48
Re: Do light chain levels need to be below 100 before a SCT?
Hi Kim,
While induction therapy is used to lower the burden of disease prior to stem cell collection, there is no absolute light chain value that renders a patient eligible or ineligible for SCT. This very much depends on the extent of disease to start, the risk category (high risk versus low risk disease), side effects to induction and expected response to more therapy and/or SCT. While lower numbers are preferred, SCT is still effective in a fraction of patients who have not responded to other induction therapies.
The good news is that achieving a VGPR is a first step to acheiving adequate disease control. So you sound to be on your way!
Best,
Heather Landau
While induction therapy is used to lower the burden of disease prior to stem cell collection, there is no absolute light chain value that renders a patient eligible or ineligible for SCT. This very much depends on the extent of disease to start, the risk category (high risk versus low risk disease), side effects to induction and expected response to more therapy and/or SCT. While lower numbers are preferred, SCT is still effective in a fraction of patients who have not responded to other induction therapies.
The good news is that achieving a VGPR is a first step to acheiving adequate disease control. So you sound to be on your way!
Best,
Heather Landau
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Dr. Heather Landau - Name: Heather Landau, M.D.
Beacon Medical Advisor
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