[Cheryl G]

Re: Lymphocytes decreasing, RDW trending up

by Cheryl G on Mon Jan 15, 2018 7:33 pm

Hi Colin,

Thanks for sharing this graph. I was not aware of the literature on RDW and prognosis in myeloma patients. In looking over some of the studies on the subject, however, it looks like RDW acts as a proxy for how extensive the disease is in a patient. When RDW is high, for example, a patient is more likely to have a high M-spike and low hemoglobin level.

Have you noticed the RDW level varying with any of your other myeloma markers, such as your M-spike, free light chain levels, hemoglobin, or blood counts?

For those who are interested, I've included below a couple links to studies about RDW and prognosis in multiple myeloma patients.

Best wishes (and Happy New Year!),
Cheryl

Some articles about RDW and prognosis in multiple myeloma patients:

"Elevated red blood cell distribution width as a simple prognostic factor in patients with symptomatic multiple myeloma,"
https://www.hindawi.com/journals/bmri/2014/145619/

"Evaluation of pretreatment red cell distribution width in patients with multiple myeloma"
https://content.iospress.com/articles/cancer-biomarkers/cbm170032

"Prognostic Value of Elevated Red Blood Cell Distribution Width in Chinese Patients with Multiple Myeloma"
http://www.annclinlabsci.org/content/47/3/282

[Colin]

Re: Lymphocytes decreasing, RDW trending up

by Colin on Mon Jan 15, 2018 8:25 pm

Hi Cheryl.

I haven't observed any correlation with the elevated RDW and other blood test parameters. Thanks for the links. I did read these and others but have concluded that there isn't a lot of weight behind RDW as a prognostic marker for multiple myeloma. My M-spike continues to drop (ever so slowly) and nothing else looks out of whack.

My hematologist has not requested free light chain testing since my autologous stem cell transplant last June. He says my free light chain levels do not seem to be involved with my form of multiple myeloma. I have never really bought into his theory on that, and I believe things can change with multiple myeloma I'll add it to my list for discussion on my next visit.

[JC1]

Re: Lymphocytes decreasing, RDW trending up

by JC1 on Mon Jan 15, 2018 9:58 pm

I had a very high RDW after my first auto, and went on to have have six years with no maintenance therapy and my multiple myeloma stayed in CR. For me, treatments send my RDW higher.

[GoDucks]

Re: Lymphocytes decreasing, RDW trending up

by GoDucks on Tue Jan 16, 2018 1:01 am

Hi Colin,

I had my autologous stem cell transplant about a month after you did. My M-spike dropped significantly during treatment with Revlimid, Velcade, and dexamethasone (RVD) prior to the stem cell transplant and then went up in the time between stopping RVD and the actual transplant. I just hit my 60 day post transplant and my M-spike is still present, but also dropping slowly, currently at 1.2 g/dL.

My red blood cells, hemoglobin, and RDW are also jumping around, down one week, up the next.

I'm also wondering if the drop in red blood cells and hemoglobin is related to the antibiotic I'm on to prevent pneumonia. Normally Bactrim (sulfamethoxazole and trimethoprim) is the antibiotic used, but because I'm allergic to sulfa, I was prescribed dapsone. The side effect information for dapsone includes the following statement:

"Hematologic side effects have been the most pronounced. These have included methemoglobinemia, aplastic anemia, leukopenia, agranulocytosis, eosinophilia, macrocytic anemia, and Heinz bodies. Dapsone may induce a dose-related hemolytic anemia ..."

I guess it's always something new. Hope you are doing well in your recovery.