[sas3]

M-spike creeping up post ASCT - did it happen to you?

by sas3 on Thu Jun 25, 2015 10:58 am

I am wondering if my auto stem cell transplant has had any effect. My m-spike seems to be creeping upward, but my oncologist assures me that it is stable and that the transplant appears successful in sustaining the very good partial response (VGPR) achieved during my induction treatment.

I was diagnosed in August with IgG kappa multiple myeloma. I did 5 cycles of Revlimid, Velcade, and dexamethasone (RVD) and underwent my autologous stem cell transplant (ASCT) in Feb­ruary.

My M-spike at diagnosis was 5.87 g/dL (58.7 g/L), and went down to a steady 0.74 - 0.78 g/dL for the several weeks leading up to my transplant. Since the transplant, the M-spike results from March until now have been: 0.58, 0.62, 0.69 and 0.78 (the same as just before transplant).

Some of my other numbers look like they are going in the right direction. My B2 microglobulin was 5.89 at diagnosis, 1.43 just before transplant, and is now 1.19. My kappa/lambda free light chain ratio was 126.31 at diagnosis, 1.66 pre-transplant, and 1.13 now.

Has anyone had the experience where the M-spike stayed the same, or had a minor increase like this, just after transplant, but held onto a steady response for a good period of time?

I'm worried that the transplant didn't do anything and that I need drug therapy to keep my myeloma at bay.

Thanks!

[blair77]

Re: M-spike creeping up post ASCT - did it happen to you?

by blair77 on Sat Jun 27, 2015 7:21 pm

This didn't happen to my husband but I know many have had it happen. My husband's M-spike was / is at 0 post transplant, and he still does Revlimid therapy to try and keep it that way as long as possible! So don't worry too much if you need some sort of maintenance to keep it in check!

[rFidalgo1]

Re: M-spike creeping up post ASCT - did it happen to you?

by rFidalgo1 on Thu Jul 16, 2015 9:30 pm

Hello there,

I didn't have a stem cell transplant but when I started treatment in January 7, 2013 was initially put on Rd [Revlimid and dexamethasone]. After 5 months I stopped Revlimid and stayed on the dex at 12 mg every Saturday for another 1 1/2 years until the dex did not keep me in VGPR [very good partial response]. I am now experimenting with Kyprolis (Velcade didn't work very well) and doing fine.

My M-Spike was around 0.44 while I was in remission. You might consider a light dose of dex to keep your M-Spike low and help the transplant. It kept me in remission for a 1 1/2 before it lost its power.

Talk it over with your hematologist but glad to hear that your K/L ratio is holding greatly.

Rita B

[JPC]

Re: M-spike creeping up post ASCT - did it happen to you?

by JPC on Thu Jul 16, 2015 10:15 pm

Hello, RF:

Here is a suggestion to you. See if there was done a flow cytometry on the pre and post bone marrow biopsies, on the aspirate. That is a more sophisticated test than the M-Spike level, and may inform you as to the effectiveness of the transplants.

Best of luck, JPC

[Bill Snyder]

Re: M-spike creeping up post ASCT - did it happen to you?

by Bill Snyder on Fri Jul 17, 2015 2:49 am

If your kappa / lambda free-light-chain is very stable even while your IgG-spike is slowly rising, this could be a positive sign. Unless other testing is confirming monoclonal proteins while your free-light ratio is stable, some of, most of, or even potentially all of what you call your M-spike could just hopefully be your normal immune system coming back slowly.

If your real M-spike is rising from active myeloma, then your free light chain ratio should also be rising just as fast or faster. That's the way I understand it. Someone correct me if I am wrong!

Thanks!