Hi,
My father has been diagnosed with IgM multiple myeloma (kappa type) phase 3A with no lesions, low blood counts, 2 months back.
M-spike: 3.13,
Serum kappa light chains: 69.9
Serum lambda light chain: 48.3.
His blood counts were low:
Hb: 8.2,
WBC: 2100
Platelets: 82,000.
He started treatment with bortezomib [Velcade] + dexamethasone and has completed 10 doses. Latest reports show the following results:
M-spike: 3.1
Serum kappa light chains: 21.3
Serum lambda light chains: 11.7
No difference in M-spike result even after 2 months of therapy, but good reduction in light chains.
Please let me know what happens if M-spike continues with same value?
Please note that his blood counts have improved to:
Hb: 10.3
WBC: 3200
Platelets: 109,000.
Thanks,
Pankaj.
Forums
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PankajSri - Name: PankajSri
- Who do you know with myeloma?: My father
- When were you/they diagnosed?: My father's been diagnosed 2 months back
- Age at diagnosis: 81
Re: M-spike not dropping after 2 months of therapy
I'm sure this is a scary as hell time, for you and your family.
However, I would ask you to practice some patience.
My M spike did not immediately respond to the Velcade / dex, either. However, my SPEP DID respond, just as your fathers, has done.
SPEP is more sensitive, I'd suggest. Improving blood counts is also a good thing to see.
Patience.
Good luck.
However, I would ask you to practice some patience.
My M spike did not immediately respond to the Velcade / dex, either. However, my SPEP DID respond, just as your fathers, has done.
SPEP is more sensitive, I'd suggest. Improving blood counts is also a good thing to see.
Patience.
Good luck.
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Rneb
Re: M-spike not dropping after 2 months of therapy
Pankaj,
First off, I'm not a doctor. But did the doctor rule out Waldenström macroglobulinemia (WM) when your father was first diagnosed with IgM multiple myeloma? As I recall, one needs a bone marrow biopsy to distinguish between WM and multiple myeloma.
First off, I'm not a doctor. But did the doctor rule out Waldenström macroglobulinemia (WM) when your father was first diagnosed with IgM multiple myeloma? As I recall, one needs a bone marrow biopsy to distinguish between WM and multiple myeloma.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: M-spike not dropping after 2 months of therapy
Thanks a lot for your reply. Yes, my father did undergo a bone marrow biopsy and it confirmed multiple myeloma. His SPEP results are as follows:
Serum Total Proteins: 8.10 (dropped from 10.1 taken 2 months back)
Serum Albumin: 3.39 (increased from 2.9 taken 2 months back)
Alpha 1 Globulin: 0.22
Alpha 2 Globulin: 0.45
Gamma Globulin: 3.47 (higher than reference range)
Albumin: Globulin: 0.72 (lower than reference range)
M Band: Seen (3.10 g/dl)
Comment: Monoclonal gammopathy
As you can see, total proteins have reduced from 10.1, albumin increased from 2.9, light chains reduced by one-third, but m-spike continues to be the same.
Doctor hinted during our last visit that he may have to take thalidomide capsules (100 mg) with anti-coagulant (Ecospirin) for 30 days. We are worried as thalidomide is being prescribed in addition to the weekly therapy (bortezomib + dex) which could have greater side-effects apart from likelihood of blood clots.
Please let me have your views on this or if anyone has taken thalidomide in addition to the ongoing therapy may please share their experiences.
Secondly, there are two other symptoms my father is experiencing:
I) Excess production of saliva in mouth and
2) Slight swellings on both legs (before treatment started, swelling was more, now it's reduced).
I don't know whether this is due to myeloma. We had raised this with our doctor but no solution yet.
Thanks,
Pankaj.
Serum Total Proteins: 8.10 (dropped from 10.1 taken 2 months back)
Serum Albumin: 3.39 (increased from 2.9 taken 2 months back)
Alpha 1 Globulin: 0.22
Alpha 2 Globulin: 0.45
Gamma Globulin: 3.47 (higher than reference range)
Albumin: Globulin: 0.72 (lower than reference range)
M Band: Seen (3.10 g/dl)
Comment: Monoclonal gammopathy
As you can see, total proteins have reduced from 10.1, albumin increased from 2.9, light chains reduced by one-third, but m-spike continues to be the same.
Doctor hinted during our last visit that he may have to take thalidomide capsules (100 mg) with anti-coagulant (Ecospirin) for 30 days. We are worried as thalidomide is being prescribed in addition to the weekly therapy (bortezomib + dex) which could have greater side-effects apart from likelihood of blood clots.
Please let me have your views on this or if anyone has taken thalidomide in addition to the ongoing therapy may please share their experiences.
Secondly, there are two other symptoms my father is experiencing:
I) Excess production of saliva in mouth and
2) Slight swellings on both legs (before treatment started, swelling was more, now it's reduced).
I don't know whether this is due to myeloma. We had raised this with our doctor but no solution yet.
Thanks,
Pankaj.
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PankajSri - Name: PankajSri
- Who do you know with myeloma?: My father
- When were you/they diagnosed?: My father's been diagnosed 2 months back
- Age at diagnosis: 81
Re: M-spike not dropping after 2 months of therapy
With multiple myeloma, sometimes we need a little patience. However, my general rule is in a newly diagnosed patient, I would expect to see a response after 2 cycles. If I do not see a reasonable response, then I feel it is time to change therapy (or at a minimum tweak it).
I do not know the practice patterns where you are. If your father was in my clinic, I would either add Cytoxan [cyclophosphamide] (weekly) or Revlimid [lenalidomide] to the Velcade and dex.
If the M-spike is not dropping, then we are not controlling disease and not stopping the multiple myeloma from causing organ damage (CRAB). Depending on your father's general health (performance status), changing to Revlimid / dex may be reasonable as well (2 drugs vs 3). I am generally a 3-drug induction person.
In some patients, it is difficult to control the disease and we have to work a little harder. Even in the face of all of the success we have had in multiple myeloma over the years, it remains a very challenging disease to have and to treat.
Watch for both dex and Velcade side effects (the most likely culprits for your dad's new symptoms).
We wish you the best of luck.
I do not know the practice patterns where you are. If your father was in my clinic, I would either add Cytoxan [cyclophosphamide] (weekly) or Revlimid [lenalidomide] to the Velcade and dex.
If the M-spike is not dropping, then we are not controlling disease and not stopping the multiple myeloma from causing organ damage (CRAB). Depending on your father's general health (performance status), changing to Revlimid / dex may be reasonable as well (2 drugs vs 3). I am generally a 3-drug induction person.
In some patients, it is difficult to control the disease and we have to work a little harder. Even in the face of all of the success we have had in multiple myeloma over the years, it remains a very challenging disease to have and to treat.
Watch for both dex and Velcade side effects (the most likely culprits for your dad's new symptoms).
We wish you the best of luck.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: M-spike not dropping after 2 months of therapy
On the question of Waldenström's macroglobulinemia (WM) vs IgM multiple myeloma, it is an important distinction to be made.
IgM multiple myeloma is a very rare entity - by far the least common paraprotein class. In fact, it is less frequently seen than the ~1500 cases of WM seen in the US annually. However, WM has very classic marrow findings that should be discernible from multiple myeloma.
For the most part, confusion with WM is with other indolent B cell lymphomas. With new findings regarding mutations in MYD88 and CXCR4, we are improving our ability to appropriately diagnosis WM and maybe even treat it.
Excellent point.
IgM multiple myeloma is a very rare entity - by far the least common paraprotein class. In fact, it is less frequently seen than the ~1500 cases of WM seen in the US annually. However, WM has very classic marrow findings that should be discernible from multiple myeloma.
For the most part, confusion with WM is with other indolent B cell lymphomas. With new findings regarding mutations in MYD88 and CXCR4, we are improving our ability to appropriately diagnosis WM and maybe even treat it.
Excellent point.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: M-spike not dropping after 2 months of therapy
Hello Dr. Ken,
Thanks a lot for your reply. After 2 months of therapy, what is puzzling us is that my father feels much better, almost normal in fact. His kappa and lambda light chains have reduced to one-third (lambda within normal range), and his blood counts that were quite low 2 months back (Hb: 8.2, WBC:2000, platelets: 82,000), now improved to Hb: 10.3, WBC:3200, platelets: 1,09,000.
But only parameter that has not changed is m-spike (3.1 g/dl).
My only question: taking thalidomide in addition to Velcade + dex therapy, will it not be risky?
As it is, Velcade has its own side effects, I believe.
But with God's grace so far, there have been no side effects.
Thanks,
Pankaj.
Thanks a lot for your reply. After 2 months of therapy, what is puzzling us is that my father feels much better, almost normal in fact. His kappa and lambda light chains have reduced to one-third (lambda within normal range), and his blood counts that were quite low 2 months back (Hb: 8.2, WBC:2000, platelets: 82,000), now improved to Hb: 10.3, WBC:3200, platelets: 1,09,000.
But only parameter that has not changed is m-spike (3.1 g/dl).
My only question: taking thalidomide in addition to Velcade + dex therapy, will it not be risky?
As it is, Velcade has its own side effects, I believe.
But with God's grace so far, there have been no side effects.
Thanks,
Pankaj.
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PankajSri - Name: PankajSri
- Who do you know with myeloma?: My father
- When were you/they diagnosed?: My father's been diagnosed 2 months back
- Age at diagnosis: 81
Re: M-spike not dropping after 2 months of therapy
Dr. Shain has given you some really important information about how he changes treatment with people who either are slow to respond to treatment or don't respond very quickly. Thalidomide is an older drug than Revlimid. If Revlimid is available in your country, please let us know where you are, and has a much lower side effect profile than thalidomide. But, thalidomide in combination with Velcade and dex are commonly used combinations of drugs in the US.
Thalidomide often causes peripheral neuropathy, numbness / pain in the feet / legs / hands / feet, and needs to be stopped or dose reduced when any sign of neuropathy begins to develop. If your father is receiving Velcade via infusion rather than the newer administration by subcutaneous injection, then the probability of developing neuropathy increases significantly.
It is very common in the US these days to begin treatment with a 3 drug combination. So, your father's oncologist is thinking in very acceptable and safe ways. It may be the addition of the 2 new drugs that really begin to attack the m-spike. Obviously from the numbers that you have posted your father is responding to treatment. So, I personally would predict that he will continue to respond well.
Your father is most fortunate to have a son to ask these questions on the forum. The best to your father and to you and the rest of your family.
Nancy in Phila
Thalidomide often causes peripheral neuropathy, numbness / pain in the feet / legs / hands / feet, and needs to be stopped or dose reduced when any sign of neuropathy begins to develop. If your father is receiving Velcade via infusion rather than the newer administration by subcutaneous injection, then the probability of developing neuropathy increases significantly.
It is very common in the US these days to begin treatment with a 3 drug combination. So, your father's oncologist is thinking in very acceptable and safe ways. It may be the addition of the 2 new drugs that really begin to attack the m-spike. Obviously from the numbers that you have posted your father is responding to treatment. So, I personally would predict that he will continue to respond well.
Your father is most fortunate to have a son to ask these questions on the forum. The best to your father and to you and the rest of your family.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: M-spike not dropping after 2 months of therapy
Thanks a lot for your reply, Nancy.
Last week, we had some anxious moments, with my father admitted to a hospital with fever that just refused to go away. His WBC slipped to as low as 1600. After a heavy dosage of antibiotics, finally the fever that was caused by bacterial infection has subsided and he's now discharged from hospital.
Due to this, there's been a temporary break in his anti-myeloma therapy. During his hospitalization period, we discovered 2 new problems.
First, heart palpitations were observed, he underwent echo test that revealed he has Ischemic heart disease with his right ventricle and artery dilated. However, the echo report rules out any presence of blood clots.
Secondly, swellings in ankles and feet seems to have led to increase in his weight by 4-5 kgs (9-11 lbs). We plan to consult a cardiologist regarding this.
Now, the questions that arise are the following:
Thanks, Pankaj.
Last week, we had some anxious moments, with my father admitted to a hospital with fever that just refused to go away. His WBC slipped to as low as 1600. After a heavy dosage of antibiotics, finally the fever that was caused by bacterial infection has subsided and he's now discharged from hospital.
Due to this, there's been a temporary break in his anti-myeloma therapy. During his hospitalization period, we discovered 2 new problems.
First, heart palpitations were observed, he underwent echo test that revealed he has Ischemic heart disease with his right ventricle and artery dilated. However, the echo report rules out any presence of blood clots.
Secondly, swellings in ankles and feet seems to have led to increase in his weight by 4-5 kgs (9-11 lbs). We plan to consult a cardiologist regarding this.
Now, the questions that arise are the following:
- Are myeloma and heart issue of this nature completely unrelated?
- With this recent development, does this add a new complication in the resumption of his therapy (Velcade + dex + possibly thalidomide) and to his anti-myeloma treatment in general?
Thanks, Pankaj.
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PankajSri - Name: PankajSri
- Who do you know with myeloma?: My father
- When were you/they diagnosed?: My father's been diagnosed 2 months back
- Age at diagnosis: 81
Re: M-spike not dropping after 2 months of therapy
PankajSri, I am going to try to answer your questions below.
Are myeloma and heart issue of this nature completely unrelated?
Treatments can be associated with the development of heart problems. They don't cause ischemic heart disease, but could certainly exacerbate them in times of stress like your father is going through.
With this recent development, does this add a new complication in the resumption of his therapy (Velcade + dex + possibly thalidomide) and to his anti-myeloma treatment in general?
Yes, any time there are additional comorbidities (other medical problems not related to myeloma: heart disease, lung disease and liver disease) can make treatment of myeloma more challenging. Ideally, his heart issues will be addressed and treated before getting back on treatment.
One final point about your prior posts. Sometimes the IgM protein is hard to accurately measure on the SPEP. In that case, measuring the total IgM is helpful.
Best wishes to you and your father,
Jlk
Are myeloma and heart issue of this nature completely unrelated?
Treatments can be associated with the development of heart problems. They don't cause ischemic heart disease, but could certainly exacerbate them in times of stress like your father is going through.
With this recent development, does this add a new complication in the resumption of his therapy (Velcade + dex + possibly thalidomide) and to his anti-myeloma treatment in general?
Yes, any time there are additional comorbidities (other medical problems not related to myeloma: heart disease, lung disease and liver disease) can make treatment of myeloma more challenging. Ideally, his heart issues will be addressed and treated before getting back on treatment.
One final point about your prior posts. Sometimes the IgM protein is hard to accurately measure on the SPEP. In that case, measuring the total IgM is helpful.
Best wishes to you and your father,
Jlk
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Dr. Jonathan Kaufman - Name: Jonathan Kaufman, M.D.
Beacon Medical Advisor
15 posts
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