[Jaco]

M-spike increasing after mini-allo transplant

by Jaco on Wed Aug 01, 2018 8:49 am

Hello,

I was diagnosed at the age of 41 in May of 2016. I had multiple lesions in the back, hip, and skull. I have a standard-risk form of multiple myeloma. At that time, the M-protein (M-spike) was 60 g/L (6 g/dL). I had induction therapy using cyclophosphamide, Velcade (bortezomib), and dexamethasone (CyborD), which brought the M-protein down to 18 g/L (1.8 g/dL). In October 2016, I did an auto transplant, which brought the M-protein down to 5.2 g/L (0.52 g/dL). On January 27, 2017, I did my mini-allo (reduced intensity). The M-protein has stayed around 3.2 g/L (0.32 g/dL), even had a couple lower readings 2.4 g/L and 2.8 g/L. But the last few months,’ things have changed and we are seeing an increase and it has been very disappointing to say the least.

Here are last readings:

Date M-spike M-spike
---- (g/L) (g/dL)
April 6, 2018 3.1 0.31
May 3, 2018 4.3 0.43
May 31, 2018 3.9 0.39
June 29, 2018 6.3 0.63
July 30, 2018 7.4 0.74

During my last visit (early July) with my doctors, they seem to think I was experiencing normal fluctuations caused by the new immune system adjusting and some myeloma activity. I am experiencing no clinical symptoms and would say this has been the best I have felt in a very long time. Based off of my readings, it seems to me that I am very close to having a biochemical relapse.

From what I recall, my doctor says she would not treat until I reach 10 g/L (1.0 g/dL). The treatment would likely be Revlimid and then, if need be, donor lymphocyte infusions (DLI’s) later when/if the Revlimid starts failing? I think the Revlimid would be a low dose hoping to provoke some graft vs. myeloma activity, however, I am not sure how she intends to use it.

Am I correct that my M-protein is now probably on a continuous rise? Or is it possible, even likely, that my M-protein / M-spike might go down again, and this is just temporary?

Any insight would be really appreciated.

Thank you,
Peter

[Falcon]

Re: M-spike increasing after mini-allo transplant

by Falcon on Fri Aug 10, 2018 9:11 pm

My wife had an allogeneic stem cell transplant and still has a small M-spike, but her bone marrow biopsy says 100% chimerism and polyclonal, no monoclonal plasma cells in the bone marrow. What does your bone marrow biopsy say? Her M-spike appears through her blood test (serum electrophoresis test). Her urine does not show any paraprotein.

My wife has a fairly low, consistent, M0spike coming from the bone and has some bone plasma­cytomas that we are dealing with through radiation therapy. The myeloma is no longer in her bone marrow, however, and it is in sites away from the bone marrow and is hanging on in the form of small plasmacytomas that are being treated. She has had one donor lymphocyte infusion following the transplant.

Do they have you on a maintenance treatment? My wife has a maintenance infusion every two weeks.

You may have some spot of myeloma activity that is resulting in the M-spike. Did they do a CT scan or PET scan recently? She had a PET scan and we could see the hot spots.