[Dr. Ken Shain]

Re: Lucent lesions

by Dr. Ken Shain on Fri Feb 15, 2013 7:06 pm

Regarding lytic lesions. A few things need to clarified for you:

1) Are these really new? You may have had lesions at diagnosis. Although lesions can improve with therapy including bisphosphonate, they do not always go away completely or even resolve for that matter. Comparisons to you original survey will be important or addtional imaging like a CT scan can help in some cases may better define these as lytic or other lucensies. I would wait until the follow-up bone survery is completed. Also depending on the time between your initial bone survery and start of therapy lesions can arise (think along the lines of a month, not just a few days).

2) Are these really lytic lesions? Sometimes imaging is less then perfect and films can be over interpruted. Again, lets wait for the follow-up studies.

3) you are correct with a VGPR (90% reductions in your paraproteins) you should not have evidence of organ damage progression. If there are concerns after the bone survery and CT scans of your arm and shoulder, then I would restage you with bone marrow biopsy, SPEP-IFE, UPEP-IFE, SFLCs.

We wish you the best

[Ladyaero]

Re: Lucent lesions

by Ladyaero on Thu Feb 21, 2013 4:44 pm

My husband's blood work all showed no m-spike at all in August/September (from an initial high of 3.4 in 2010, knocked down by Velcade and then a stem cell transplant), but he had bone pain and 2 new lumps (one on his shin, one on his scalp). Biopsy of the lump on his shin showed it was a plasmacytoma. They did a PET scan and the scan said that the shin was the only active area- but the bump on his head continued to grow. When it was big enough, they biopsied the bump on his head and it, too, was myeloma. They did radiation on those two spots, but then the arm pain was also shown to be myeloma related, and he has a handful of tiny new lumps started (chemo is back on the menu now). Through all of this, no m-spike and only very recently (after almost 6 months of tumors growing) the tiniest of evidence with light chains. All that is just to say that it *is* possible to have plasmacytomas growing while all of the regular tests keep reporting no active disease.

[Nancy Shamanna]

Re: Lucent lesions

by Nancy Shamanna on Thu Feb 21, 2013 6:48 pm

Hi Ladyaero, Hope that your husband's myeloma can be put back into remission. It is discouraging to know that even with very little sign of the FLC's in the blood, he could have been having plasmacytomas! That is something else to worry about...good thing you caught that early.

[Dr. Ken Shain]

Re: Lucent lesions

by Dr. Ken Shain on Fri Feb 22, 2013 8:49 pm

Myeloma is not always a straight forward disesae. Most individuals relapse serologically-in blood (or in the urine); however, there are patients whose disease has changed and no longer produce as much monoclonal paraprotein, all of the Ig (e.g. was IgG kappa and now only light chain diseas), and some produce different Igs.

In your case the light chains are not the indicator of relapsed disease. The recurrent and apparently numerous plasmacytomas are the evidence of relapsed disease. And as you mentioned you are back on systemic therapy for relapsed myeloma.

We wish you the best of luck and keep us informed.