Hello everyone
I know I have created a previous post which received several replies from several persons in the community. I am very thankful for that.
I wanted to make a little summary of everything I have learned regarding my mother in the hope that some of you may tell me what grade of risk she has of evolving to multiple myeloma.
Here is what I now know:
IgA lambda.
FLC ratio is 0.11
Beta2microglobulin is 2.9
Albumin is 38.8g/l
2 M spikes: beta spike is 9.5g/l and gamma spike is 3.1g/l
Sed rate 135
Bone marrow biopsy (plasma cell percentage) 50%
Cytogenetics:
-No del 17p13 in 100% of analyzed nuclei.
-Deletion of loci of either 13q14 or 13q34 in 75% of analyzed nuclei
-Translocation t(14;16) in 85% of analyzed nuclei
No CRAB symptoms at present
One small detail: we know her sed rate was the same for over 2 years but, at the time, she never looked into it. It is therefore believed that she had this condition for the last 1.5-2 years at least.
I would be very thankful if you could tell me what you all think.
Are we looking at a standard / low / high risk of evolution case?
Many thanks in advance for all your future replies.
Maro
Forums
10 posts
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Maro - Who do you know with myeloma?: My mom
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 63
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Maro - Who do you know with myeloma?: My mom
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 63
Re: Low, standard, or high risk smoldering myeloma?
Hi Maro,
There are different models for evaluating the risk of progression from SMM to multiple myeloma.
This is a real simple model:
http://www.qxmd.com/calculate-online/hematology/smoldering-myeloma
At > 10% bone plasma and > 3g/dL M-Spike, she would be classified as having a "high risk of progression".
And you can also look at the Mayo model, which uses this criteria:
"For SMM patients, the following features are considered to be adverse risk factors: ≥3 g/dL M-protein, an FLC ratio outside the reference range of 0.125 to 8, and ≥10% bone marrow plasma cells"
Your mom has all three of the Mayo risk factors, so the Mayo model would also classify her as having a "high risk of progression".
There is also the Spanish Pethema model that is used for risk of progression classification, but it requires unique tests to be used.
Hope this helps.
There are different models for evaluating the risk of progression from SMM to multiple myeloma.
This is a real simple model:
http://www.qxmd.com/calculate-online/hematology/smoldering-myeloma
At > 10% bone plasma and > 3g/dL M-Spike, she would be classified as having a "high risk of progression".
And you can also look at the Mayo model, which uses this criteria:
"For SMM patients, the following features are considered to be adverse risk factors: ≥3 g/dL M-protein, an FLC ratio outside the reference range of 0.125 to 8, and ≥10% bone marrow plasma cells"
Your mom has all three of the Mayo risk factors, so the Mayo model would also classify her as having a "high risk of progression".
There is also the Spanish Pethema model that is used for risk of progression classification, but it requires unique tests to be used.
Hope this helps.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low, standard, or high risk smoldering myeloma?
Thanks Multibilly. At present she has 2 factors since she has a smaller spike than 3g/DL (she has 9.5 and 3.1g per liter and not deciliter which means 1.2g/dL)
What I am more curious to understand are the FISH results since I know that they are also risk factors.
What I am more curious to understand are the FISH results since I know that they are also risk factors.
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Maro - Who do you know with myeloma?: My mom
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 63
Re: Low, standard, or high risk smoldering myeloma?
As I understand it, there is no current correlation between cytogenetic factors and the risk of progression from SMM to multiple myeloma. Cytogenetics come into play when one is symptomatic.
My mistake on not catching the units of measure on the M-Spikes.
My mistake on not catching the units of measure on the M-Spikes.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low, standard, or high risk smoldering myeloma?
Thanks for taking the time to reply Multi.
Are her cytogenetics bad in case of progression?
Are her cytogenetics bad in case of progression?
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Maro - Who do you know with myeloma?: My mom
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 63
Re: Low, standard, or high risk smoldering myeloma?
You may want to look at the Mayo's mSMART risk classification for newly diagnosed, symptomatic multiple myeloma (not SMM).
http://msmart.org/newly%20diagnosed%20myeloma.pdf
If I understand the lab results correctly, she has a t(14;16) translocation. That by itself would categorize her as having high risk multiple myeloma according to this criteria (if she were symptomatic). But, remember that she does not have active multiple myeloma. Also, please pay attention to the caveats at the front-end of this report:
"Risk stratification and individualizing treatment options is complex and based not just on the cytogenetic classification presented here, but also on various host factors, disease stage, and a variety of other prognostic factors "
A doctor therefore really needs to look at the overall picture to classify her risk (if and when she progresses to active multiple myeloma).
If she does progress to symptomatic multiple myeloma, the mSMART risk stratification will come into play for helping select the right treatment therapy. But also remember, that this is just what the Mayo has come up with...different specialists and institutions may have different treatment approaches based on all the factors listed above.
http://msmart.org/newly%20diagnosed%20myeloma.pdf
If I understand the lab results correctly, she has a t(14;16) translocation. That by itself would categorize her as having high risk multiple myeloma according to this criteria (if she were symptomatic). But, remember that she does not have active multiple myeloma. Also, please pay attention to the caveats at the front-end of this report:
"Risk stratification and individualizing treatment options is complex and based not just on the cytogenetic classification presented here, but also on various host factors, disease stage, and a variety of other prognostic factors "
A doctor therefore really needs to look at the overall picture to classify her risk (if and when she progresses to active multiple myeloma).
If she does progress to symptomatic multiple myeloma, the mSMART risk stratification will come into play for helping select the right treatment therapy. But also remember, that this is just what the Mayo has come up with...different specialists and institutions may have different treatment approaches based on all the factors listed above.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low, standard, or high risk smoldering myeloma?
Pretty contradictive. Here is what I read on the beacon:
"Patients who are ISS stage I or II, under the age of 55 years, and whose myeloma cells do not contain t(4;14), del(17p13), or 1q21 gain are classified as low-risk. About 20 percent of patients also are expected to fall in this category at diagnosis, with median overall survival of more than 10 years from diagnosis."
Different point of views with the mayo clinic?
The msmart classifies t(4;14) as intermediate risk and t(14;16) as high whereas the beacon mentions 4;14 as the dangerous one and totally excludes 14;16.
How is this possible?
"Patients who are ISS stage I or II, under the age of 55 years, and whose myeloma cells do not contain t(4;14), del(17p13), or 1q21 gain are classified as low-risk. About 20 percent of patients also are expected to fall in this category at diagnosis, with median overall survival of more than 10 years from diagnosis."
Different point of views with the mayo clinic?
The msmart classifies t(4;14) as intermediate risk and t(14;16) as high whereas the beacon mentions 4;14 as the dangerous one and totally excludes 14;16.
How is this possible?
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Maro - Who do you know with myeloma?: My mom
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 63
Re: Low, standard, or high risk smoldering myeloma?
You will find a lot of controversy and contradictions in the role of certain mutations wrt risk classification. It's also not like the Mayo is the final word on this. This lack of consensus is unfortunately common with many aspects of multiple myeloma.
That is also one of the reasons you don't just want to look at cytogenetics when thinking about risk. In fact, one of my doctors that I respect a great deal, completely downplays the role of cytogenetics and sees little (if any) value in using it as a prognosis tool or as guide for selecting the type of treatment for a given patient.
To underscore the controversy and lack of consensus on just t(14;16) as a risk factor, see:
http://bloodjournal.org/content/117/6/2009?variant=lon
That is also one of the reasons you don't just want to look at cytogenetics when thinking about risk. In fact, one of my doctors that I respect a great deal, completely downplays the role of cytogenetics and sees little (if any) value in using it as a prognosis tool or as guide for selecting the type of treatment for a given patient.
To underscore the controversy and lack of consensus on just t(14;16) as a risk factor, see:
http://bloodjournal.org/content/117/6/2009?variant=lon
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low, standard, or high risk smoldering myeloma?
Thanks for the last link Multi. It really looks like there is more disagreement than agreements in the myeloma field.
Odd though ... If no proof exists regarding t(14;16) then why classify it as high risk in the msmart ?
Odd though ... If no proof exists regarding t(14;16) then why classify it as high risk in the msmart ?
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Maro - Who do you know with myeloma?: My mom
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 63
10 posts
• Page 1 of 1