[Dr. Ken Shain]

Re: Experiencing a low grade fever - should I do anything?

by Dr. Ken Shain on Fri Jul 04, 2014 9:07 am

I would be careful to blame a serological progression of disease on new fevers. I would make sure that your are not having other issues as well, such as infections or other biological changes. Generally, relapse is only measured in the blood or urine (increasing M-spike or other paraproteins) without symptomatic disease (CRAB-I criteria).

Another possibility is a the presence of oligoclonal reconstitution. If post-transplant, your immune system reconstitution can sometimes lead to the presence of an polyclonal production of antibodies that looks like an M-spike on SPEP. This Ig will not match that of your disease. Oligoclonal reconstitution has in some cases been associated with improved outcomes (abstract from 2012 ASH meeting; see related Beacon news article).

However, I do recommend that you "listen" to you body. Without any further information regarding your case, it is very difficult to comment. At this point, you and your oncologist will need to discuss that potential relationship and degree of relapse. Patients can frequently have serological relapse that progresses very slowly and can just be monitored without therapy.

Again, it will be up to you and your myeloma doctor.

[lys2012]

Re: Experiencing a low grade fever - should I do anything?

by lys2012 on Fri Jul 04, 2014 1:13 pm

Thanks for responding Doctor Shain.

My doctor hopes it will be low level relapse which will not require treatment for a year or so (her words) and then we will do intensive treatment, followed by a second stem cell transplant. Since I'm only 36, my treatment plan is more aggressive to hopefully get back into a long remission again.

All other causes of fevers were ruled out in my case (no infections etc). I'm 4 years out from my transplant so had recovered pretty well with no detectable myeloma for 4 years. The M-spike is showing up the same as my original myeloma spike(IgG lambda), so, unfortunately, it seems to be myeloma coming back

Interesting about the symptoms. The first time around I had a lot of fevers / sweats / infections / migraines. Other then the fevers / sweats, I've noticed a definite increase in migraines since March. After only the odd one for the last 4 years (couple times a year), I'm now having them every week or so since March. Yes, I know not typical myeloma symptoms, but my case has been anything but normal from the very beginning!

I have had a xray bone survey last week and it shows osteopenia (new for me). I'm in the watchful waiting stage now with more frequent blood work and follow ups.

[Ian]

Re: Experiencing a low grade fever - should I do anything?

by Ian on Fri Jul 04, 2014 10:15 pm

Hi lys2012,

About your migraines ... That's interesting. There have been cases discussed here in the forum of people who have experienced varying degrees of confusion prior to their myeloma diagnosis. I believe this happens because the myeloma thickens the blood, depriving the brain of sufficient oxygen and other nourishment, creating the confusion.

Maybe there's something similar going on that causes your migraines.

It believe there is what is called a blood viscosity test that determines how "thick" the blood is. In some myeloma patients that experience confusion as a symptom of the disease, the viscosity is elevated. Perhaps your doctor could arrange for you to have such a blood test done. I suspect it's a relatively simple test that won't be expensive.

[lys2012]

Re: Experiencing a low grade fever - should I do anything?

by lys2012 on Sat Jul 05, 2014 12:12 am

Funny you should mention that! I was diagnosed with hyperviscocity (thick blood) when I first was diagnosed with multiple myeloma in 2010. This is a rare in multiple myeloma symptom. According to my oncologist only 5 % of multiple myeloma patients experience this. It is caused by very high m protein in the blood that makes it thick. Right now my spike is still low so I'm hoping it stays that way

[Dr. Ken Shain]

Re: Experiencing a low grade fever - should I do anything?

by Dr. Ken Shain on Sat Jul 05, 2014 8:11 am

You are right, an atypical presentation. Hyperviscosity syndrome from very high levels of M-spike (paraprotein) can cause a number of vague symptoms from "thickened" blood. With low level serological relapse, however, that should not be a major issues. Based on your history, I would suspect that your myeloma doctor will likely check it when / if your paraprotein continues to rise though.

Your symptoms may be related, based on what you have stated about your presentation. I would try to get symptomatic management for the migraines and others. Keep an eye on all of them.

Again, best of luck.