Hello,
I have a question regarding my father's M-spike and what it's done over the course of about a year. It has gone from 0.2 g/dL (0.02 g/L) in early 2014 all the way to 1.2 g/dL from his latest blood test result. (Dad had his stem cell transplant in September 2013 and he was at 0.4 g/dL going into the transplant.)
Dad's Revlimid dosage was recently lowered from 20 mg to 10 mg (due to platelets going too low), but only now his oncologist has decided to take him off Revlimid completely and put him on Velcade and dex.
My main question: How can M-spike be continually rising when CBC tests are coming back OK? WBC / RBC / Hgb are all, and have been, normal range, and light chains were normal as of last month.
Absolute grans & absolute lymphs are sometimes a bit out of the normal range on the low side. Any comments/opinions would be greatly appreciated.
P.S. – Should also mention dad feels very good, no bone pain, no infections, etc. Very active on a daily basis.
Chris in CT
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chris0830 - Name: Chris B
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: Jan 2013
- Age at diagnosis: 67
Re: M-spike up / blood counts stable on Revlimid maintenance
Hi Chris,
My understanding is that it's really the M-spike and free light chain levels that you should be paying attention to when tracking how myeloma is reacting to treatment. You want to look at the blood cell counts to make sure they're not getting too low as a side effect of treatment, but it's the M-spike and free light chains that really tell you about what's happening with the disease.
What type of multiple myeloma does your father have? IgG? IgA?
Also, when your father's M-spike went up, what happened to his serum free light chain levels? Were they measured at the same time your father's M-spike was measured?
My understanding is that it's really the M-spike and free light chain levels that you should be paying attention to when tracking how myeloma is reacting to treatment. You want to look at the blood cell counts to make sure they're not getting too low as a side effect of treatment, but it's the M-spike and free light chains that really tell you about what's happening with the disease.
What type of multiple myeloma does your father have? IgG? IgA?
Also, when your father's M-spike went up, what happened to his serum free light chain levels? Were they measured at the same time your father's M-spike was measured?
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Jonah
Re: M-spike up / blood counts stable on Revlimid maintenance
Hi Jonah,
Thanks for your reply. Forgot to mention: Dad's myeloma type is IgG. He was diagnosed January, 2013, stage 3 with no bone / kidney involvement / deletions of any kind. Was very anemic at the time and did have 80% plasma finding at his bone marrow biopsy (BMB) shortly after diagnosis.
Regarding the light chains, I'm not sure of what they were this past blood test last from week, but generally over the past year the ratio has bounced around between normal and slightly outside of the normal range.
I do remember about 6 months ago his light chain ratio was just over 3, yet went down the next time back into the normal range when the M-spike actually went up.
Thanks for your reply. Forgot to mention: Dad's myeloma type is IgG. He was diagnosed January, 2013, stage 3 with no bone / kidney involvement / deletions of any kind. Was very anemic at the time and did have 80% plasma finding at his bone marrow biopsy (BMB) shortly after diagnosis.
Regarding the light chains, I'm not sure of what they were this past blood test last from week, but generally over the past year the ratio has bounced around between normal and slightly outside of the normal range.
I do remember about 6 months ago his light chain ratio was just over 3, yet went down the next time back into the normal range when the M-spike actually went up.
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chris0830 - Name: Chris B
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: Jan 2013
- Age at diagnosis: 67
Re: M-spike up / blood counts stable on Revlimid maintenance
Hi Chris,
I just read your first posting more carefully and realized that your father's M-spike of 1.2 wasn't just a one-time reading, but, instead, his M-spike has been trending up most of the past year.
If that is the case, and the M-spike of 1.2 isn't just a fluke but the continuation of a trend, then I think the numbers have to be believed, regardless of what has been happening with his blood counts.
Calculating an M-spike isn't an exact process, particularly for IgA myeloma, which is why I asked what type of myeloma your father has. But if there's a clear trend over time in the M-spike, the numbers are probably correct.
Keep in mind, though, that having an M-spike of 1.2 g/dL doesn't mean your father needs to change his treatment drastically. There are myeloma patients who have M-spikes of 2 or higher but maintain that M-spike for extended periods of time with no change in treatment. Smoldering myeloma patients can have M-spikes at that level, or even higher, and be stable for many years, not requiring treatment.
If you haven't done it already, I would plot your dad's M-spike over the last year, and also plot his kappa and lambda free light chain levels and his free light chain ratio. There's nothing like seeing the values plotted in a graph to help you understand how much they're really changing over time, and it also will help you realize if a test result is really out of whack.
I hope this helps. I (and others here in the forum) can try to answer more questions if you have any.
I just read your first posting more carefully and realized that your father's M-spike of 1.2 wasn't just a one-time reading, but, instead, his M-spike has been trending up most of the past year.
If that is the case, and the M-spike of 1.2 isn't just a fluke but the continuation of a trend, then I think the numbers have to be believed, regardless of what has been happening with his blood counts.
Calculating an M-spike isn't an exact process, particularly for IgA myeloma, which is why I asked what type of myeloma your father has. But if there's a clear trend over time in the M-spike, the numbers are probably correct.
Keep in mind, though, that having an M-spike of 1.2 g/dL doesn't mean your father needs to change his treatment drastically. There are myeloma patients who have M-spikes of 2 or higher but maintain that M-spike for extended periods of time with no change in treatment. Smoldering myeloma patients can have M-spikes at that level, or even higher, and be stable for many years, not requiring treatment.
If you haven't done it already, I would plot your dad's M-spike over the last year, and also plot his kappa and lambda free light chain levels and his free light chain ratio. There's nothing like seeing the values plotted in a graph to help you understand how much they're really changing over time, and it also will help you realize if a test result is really out of whack.
I hope this helps. I (and others here in the forum) can try to answer more questions if you have any.
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Jonah
Re: M-spike up / blood counts stable on Revlimid maintenance
Thank you Jonah for your feedback. I'm going to accompany my dad to his appointment next week and I'm ready to ask all of my questions 
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chris0830 - Name: Chris B
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: Jan 2013
- Age at diagnosis: 67
5 posts
• Page 1 of 1