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M-spike rising on Revlimid
So we are 16 months post transplant and on 10 mg Revlimid and the M spike is starting to rise. Does this mean my hubs is refractory to Revlimid since he's only take 10 mg and no dex?
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: M-spike rising on Revlimid
Hi Blair,
In order to comment, I think folks likely want to know the trend of the values of the M-spike and free light chains over the past few tests.
In order to comment, I think folks likely want to know the trend of the values of the M-spike and free light chains over the past few tests.
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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 rising on Revlimid
I cannot say if your husband is refractory to Revlimid; the tests Multibilly mentioned and your oncologist's knowledge of your husband’s case and treatment history would be needed to answer that question.
In my case, I was on 10 mg maintenance Revlimid too when my light chain lab numbers and a bone marrow biopsy indicated my myeloma was starting to rise. The dosage was increased to 25 mg and dexamethasone was added, and within one cycle, all may light chains went back to being well within the normal range.
You probably already know your husband’s doctors will probably do the something similar if 10 mg Revlimid is no longer as effective as they would like it to be for your husband’s myeloma.
We know that Revlimid will not work forever, clinical trials have shown that. But dexamethasone greatly increases the effectiveness of Revlimid as well as being very effective by itself, and there still is lots of room to increase the Revlimid dosage safely.
Hopefully, your husband will likely still get some – maybe lots of – use out of Revlimid before having to make a drug switch. But I can say it certainly helps quality of life to be on only 10 mg with no dexamethasone, and ideally you husband can do the same for a bit longer.
Best wishes,
Eric
In my case, I was on 10 mg maintenance Revlimid too when my light chain lab numbers and a bone marrow biopsy indicated my myeloma was starting to rise. The dosage was increased to 25 mg and dexamethasone was added, and within one cycle, all may light chains went back to being well within the normal range.
You probably already know your husband’s doctors will probably do the something similar if 10 mg Revlimid is no longer as effective as they would like it to be for your husband’s myeloma.
We know that Revlimid will not work forever, clinical trials have shown that. But dexamethasone greatly increases the effectiveness of Revlimid as well as being very effective by itself, and there still is lots of room to increase the Revlimid dosage safely.
Hopefully, your husband will likely still get some – maybe lots of – use out of Revlimid before having to make a drug switch. But I can say it certainly helps quality of life to be on only 10 mg with no dexamethasone, and ideally you husband can do the same for a bit longer.
Best wishes,
Eric
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: M-spike rising on Revlimid
Thanks for the information. I think we would all feel better if we knew what plan "B" was when plan "A" stops working. We are still waiting on all tests, so I'm jumping the gun a bit.
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: M-spike rising on Revlimid
You should also check / ask if the M-spike is the same clone as the one involved at diagnosis. If it is not, it could be secondary MGUS, which is not necessarily a precursor to relapse.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: M-spike rising on Revlimid
Ok, thanks, we will check!
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: M-spike rising on Revlimid
Some feedback for anyone following this.
My husband's M spike had not increased; it's still 0 / his IFE is still negative for paraproteins and his light chains are still both high with a normal ratio. What had me assuming that his M spike had risen was that his total protein was high (8.4), but his SPEP reported an elevated polyclonal rise.
He's IgA lambda. His IgA levels AND his IgG levels are currently both high, out of range (IgG 1890, IgA 905). All his other labs are normal, no CRAB and normal PET on October 2014 and biopsy in October 2014 elevated plasma cells 5-10% with no light chain restriction.
So basically we just wait and stay on maintenance cause non of these tests paint a very clear picture. We see a myeloma specialist at UCSF and he says we just keep doing Revlimid 10 mg unless something changes.
Does anyone else have such unclear test results?
My husband's M spike had not increased; it's still 0 / his IFE is still negative for paraproteins and his light chains are still both high with a normal ratio. What had me assuming that his M spike had risen was that his total protein was high (8.4), but his SPEP reported an elevated polyclonal rise.
He's IgA lambda. His IgA levels AND his IgG levels are currently both high, out of range (IgG 1890, IgA 905). All his other labs are normal, no CRAB and normal PET on October 2014 and biopsy in October 2014 elevated plasma cells 5-10% with no light chain restriction.
So basically we just wait and stay on maintenance cause non of these tests paint a very clear picture. We see a myeloma specialist at UCSF and he says we just keep doing Revlimid 10 mg unless something changes.
Does anyone else have such unclear test results?
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
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