[KLD]

M-spike increases prior to transplant

by KLD on Wed Dec 31, 2014 6:15 pm

My husband's M-spike was 1.7 g/dL (17 g/l) at diagnosis in May 2014. He has been on RVD (Revlimid, Velcade, dexamethasone) since late May. His M-spike went down to 0.5 after 5 cycles. It was then decided to add Cytoxan (cyclophosphamide) to RVD in hopes of lowering the M-spike more prior to auto transplant. After 2 additional cycles, the M-spike is up 0.1 to 0.6 g/dL. His doctor is on vacation for another week.

Can anyone comment on the slight increase of the M-spike when doing an aggressive therapy?

The oncologist said prior to the holiday that, if the M-spike increased, my husband would start to prep for harvesting, meaning he will stop all chemo meds.

My husband has no high risk factors, very little bone involvement, and he is 59.

Any input is appreciated.

[Dr. Heather Landau]

Re: M-spike increases prior to transplant

by Dr. Heather Landau on Thu Jan 01, 2015 2:46 am

Hi KLD,

The M-spike measurement is not terribly precise, especially when the absolute value is 0.5 g/dL (5 g/l) or below, because it gets very difficult to measure. As an analogy: it is more difficult to precisely measure millimeters than it is to measure centimeters, if that makes sense.

Regardless, a 0.1 increase in the M-spike to 0.6 during more aggressive therapy should be interpreted as no further response to the addition of Cytoxan, so he has stable disease (but not progression of disease).

At this point, stem cell harvest makes sense whether or not the intent is to proceed to transplant. That is because additional chemotherapy may compromise the ability to collect stem cells in the future. And we prefer not to collect stem cells when patients are progressing, i.e. when the M-spike is increasing.

Hope that helps!

[KLD]

Re: M-spike increases prior to transplant

by KLD on Thu Jan 01, 2015 12:02 pm

Thank you for the New Year's response. I wasn't sure anyone would respond during the holiday. I appreciate your reply that answered so many of my questions. The analogy made sense.

I'm sure this is the route that will be taken. My husband has an appointment on the 7th. For­tu­nately, he is feeling well, and we are ready to move into the next phase of treating this cancer.

Thanks again,
KLD