My father was diagnosed with Stage 3 multiple myeloma. He has received 10 cycles of bortezomib (Velcade), cyclophosphamide (Endoxan, Cytoxan), and dexamethasone.
Below is the data of his medical test reports. What do the results indicate?
1. Kappa Free Light Chain
At diagnosis - 42.70
After 6 treatment cycles - 789
After 10 treatment cycles - 1470
2. Lambda Free Light Chain
At diagnosis - 11.30
After 6 treatment cycles - 10.20
After 10 treatment cycles - 7.74
3. Kappa/Lambda Ratio
At diagnosis - 3.8
After 6 treatment cycles - 77.35
After 10 treatment cycles - 189
4. Protein Electrophoresis Serum (M-Spike)
At diagnosis - 2.43
After 6 treatment cycles - 0.71
After 10 treatment cycles - 0.75
5. Immunoglobulins (current values)
IgG, Serum - 469
IgM, Serum - 28
IgA, Serum - 593
6. CBC / KFT is almost in normal values.
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nihal - Name: Nihal
- Who do you know with myeloma?: my father
- When were you/they diagnosed?: 2016
- Age at diagnosis: 70
Re: M-spike decreasing, but kappa light chain increasing
Hi Nihal,
I'm guessing that your dad has IgA kappa-type myeloma given that his IgA value is the one that is elevated? Note that IgA M-spike measurements can often be inaccurate, so it is also good to also track what the total IgA level was doing during that same period in order to see if his M-spike truly did go down over the past 10 cycles.
It also looks like he has immunoparesis since his IgM and IgG levels are suppressed.
This seems like a pretty worrisome increase in the kappa free light chain value over the past 10 cycles. I'm wondering if the myeloma disease evolved during the treatment period that in turn resulted in the disease having a more dominant light chain aspect to it?
It might make sense to discuss a rescue therapy that incorporates an IMiD such as lenalidomide (Revlimid) with the doctor. This could be Revlimid and dexamethasone (Rd) or Velcade, Revlimid, and dexamethasone (VRd). Alternatively, the regimen could involve the use of another IMiD such as pomalidomide (Pomalyst, Imnovid) and/or a different proteasome inhibitor such as carfilzomib (Kyprolis) or ixazomib (Ninlaro), depending on which drugs are available to your father in Delhi.
Others who have been down this path on this forum may have some additional suggestions.
I'm guessing that your dad has IgA kappa-type myeloma given that his IgA value is the one that is elevated? Note that IgA M-spike measurements can often be inaccurate, so it is also good to also track what the total IgA level was doing during that same period in order to see if his M-spike truly did go down over the past 10 cycles.
It also looks like he has immunoparesis since his IgM and IgG levels are suppressed.
This seems like a pretty worrisome increase in the kappa free light chain value over the past 10 cycles. I'm wondering if the myeloma disease evolved during the treatment period that in turn resulted in the disease having a more dominant light chain aspect to it?
It might make sense to discuss a rescue therapy that incorporates an IMiD such as lenalidomide (Revlimid) with the doctor. This could be Revlimid and dexamethasone (Rd) or Velcade, Revlimid, and dexamethasone (VRd). Alternatively, the regimen could involve the use of another IMiD such as pomalidomide (Pomalyst, Imnovid) and/or a different proteasome inhibitor such as carfilzomib (Kyprolis) or ixazomib (Ninlaro), depending on which drugs are available to your father in Delhi.
Others who have been down this path on this forum may have some additional suggestions.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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