[Romwic]

M protein levels during initial treatment

by Romwic on Tue Jul 07, 2015 9:26 pm

I just completed 4 cycles of Velcade, cyclophosphamide (Cytoxan), and methylprednisone. My M-protein at initial diagnosis was over 2 g/dL.

I had a compression fracture and went through a course of radiation. By the time I started my chemo regimen, which was about 4 weeks after completing radiation, my M-protein was down to 0.6. After three cycles of chemo, it was only down to 0.4. Don't have the results after cycle 4 yet.

All this time, my kappa free chain has been around 50 and lambda around 1. I will be getting a PET scan next week, after which my doctor will decide on what to do next. He said that I may be having hypo secreting myeloma cells that were not responding to the chemo and that I may have to go on some different combination. I am hoping that my PET scan will come clean.

Has anyone had similar experiences? Any advice, suggestions?

[JPC]

Re: M protein levels during initial treatment

by JPC on Wed Jul 08, 2015 7:51 am

Hello, Romwic

There is a lot of literature on the response rate of CyBorD (cyclophosphamide, Velcade, and dexamethasone). Here is a link to the summary result table of one study that came up first when I did a search.

After 4 rounds of CyBorD, you have about a 60% chance of reaching 90% reduction in the M-spike, which is called a very good partial response (VGPR). Based on your numbers, you will be right near that 90% reduction level, in all likelihood, after 4 rounds. It is also easier to get that higher percentage if your M-spike started at a higher level than yourself, at 2. So it looks like the response is fine, which is a good thing.

There are other things that could be done to deepen the response, that you will be discussing with your doctor. VGPR is good, but CR is better, and negative minimum residual disease (MRD-) is better still. At a high level, the options would be some type of continuous therapy, or ASCT.

One question for you to review with your doctor (who I hope is a specialist in myeloma) ... You mentioned you are on methylprednisone. The preferred medicine is dexamethasone, which I believe has been proved in studies to be the most active steroid in terms of anti-myeloma effect. Dex and methylprednisone are in the same class of medications, for sure. If a person has bad side effects from the dex, doctors will often substitute one of the related drugs, so at least to keep the steroid effect. If you can tolerate the dex, however, I think that is probably better in terms of potentially enhancing the response. I suggest you review that with your doctor.

Best Regards and good luck to you. JPC

[Romwic]

Re: M protein levels during initial treatment

by Romwic on Thu Jul 09, 2015 5:51 am

Thanks, JPC. Your reply was very helpful. Yes my oncologist is a myeloma specialist. I too am not sure why he put me on methyl pred as opposed to dex. I was on dex following my initial diagnosis in March and during radiation for about four weeks, given mostly to control my pain.

I will post what I find out from my PET scan next week and see what my doc recommends.

Thanks again.