[coachhoke]

Re: Measuring M-spikes less than 1.0

by coachhoke on Fri Dec 04, 2015 1:05 pm

My original diagnosis was IgG kappa, based on my bone marrow biopsy of 30 percent kappa-restricted plasma cells and M-spike 0.9 g/dl. and many lytic lesions in my back (cytogenetics analysis on FISH were normal).

After induction with Velcade-dex and two years maintenance with Revlimid, my M-spike dropped to 0.2 and has fluctuated between there and 0.08 (mostly around 0.4). My FLC have always been in normal range. No transplant. Two PET/CT scans show no active lesions. I take no medications and feel perfectly healthy.

What do I look for to determine disease progression (relapse)?

Thanks,
Coach Hoke

[Multibilly]

Re: Measuring M-spikes less than 1.0

by Multibilly on Fri Dec 04, 2015 1:45 pm

Hi Coach Hoke,

First, "progression" and "relapse" are technically different things.

But I think the above document is pretty clear on both definitions:

RELAPSE: In patients with a confirmed Partial Remission, Remission, or Complete Remission (The patient must have had an objective status of Partial Remission, Remission, or Complete Remission on two successive disease assessments performed at least six weeks apart - with or without a bone marrow biopsy.), Relapse is defined as the first occurrence of any of the following:

1. A myeloma protein increase by 100% from the lowest level recorded on study, provided the absolute magnitude of this increase is at LEAST 1 g/dL for a serum monoclonal protein or at LEAST 500 mg/24 hrs of urine M-protein;
2. A myeloma protein increase above the response criteria for PR (see criteria for Partial Remission), with the same requirements for the absolute magnitude of the protein increase;
3. Reappearance of any myeloma peak that had disappeared while on protocol treatment, provided it meets the same requirements listed above;
4. Increase in the size and number of lytic bone lesions recognized on radiographs.

PROGRESSION: Any one or more of the following:

• Serum M protein increase ≥ 25% from baseline (or an increase of ≥ 1 g/dL if serum M protein was ≥ 5 g/dL at baseline), with an absolute increase of ≥ 0.5 g/dL or
• Urine M protein increase ≥ 25% from baseline, with an absolute increase of ≥ 200 mg/24 hrs or
• If patient had serum M protein < 1 g/dL, urine M protein < 200 mg/24 hrs, and an involved serum free light chain level ≥ 10 mg/dL at baseline: ≥ 25% increase in the difference between involved and uninvolved serum free light chain level, with an absolute increase of ≥ 10 mg/dL or
• Bone marrow plasma cell percentage increase ≥ 25% from baseline, with the absolute plasma cell % ≥ 10% or
• New bone lesions or soft tissue plasmacytomas, or definite increase in size of existing bone lesions or soft tissue plasmacytomas or
• Development of hypercalcemia (corrected serum calcium > 11.5 mg/dL or 2.65

[coachhoke]

Re: Measuring M-spikes less than 1.0

by coachhoke on Sat Dec 05, 2015 11:01 am

My point is that defining relapse or disease progression and thus making treatment plans when it is so difficult to measure very low m-spike values (or as Multibilly says suspect). CRAB features are obvious, but it would be nice to get ahead of them without taking unnecessary drugs. My m-spike has never been above 1.0 and my PT/CAT SCAN shows no active lesions, but my m-spike has met the definition of progression by increasing more than 0.5g/dL (0.2 to 0.8) now back to 0.4. ALL my other numbers are in normal range without taking any drugs for the last year and I feel really great (if I could just hit the golf ball a little further).

Coach Hoke

[MMFeb16,15]

Re: Measuring M-spikes less than 1.0

by MMFeb16,15 on Sat Dec 05, 2015 11:11 am

Multibilly:

Thank you for your response. It helps me understand better.

My reading after five cycle at Mayo in September was M-spike 1.2 g/dL, kappa free light chains 11.4 mg/dl, kappa / lambda ratio 5.43. I am traveling overseas.

After sixth cycle, M-spike is zero. Immunoelectrophoresis or free light chain was not done.

After seventh cycle, M-spike is zero. Immunoelectrophoresis serum says kappa component detected, IgG component detected. Free light chain was done and kappa free light chain is 2.71 mg/dl and kappa / lambda ratio 1.49.

With this kind of low figure for free light chain and Immunoelectrophoresis figure, do I need to continue treatment till I return to Mayo in first week of January after eight cycle?

Thank you.

[Multibilly]

Re: Measuring M-spikes less than 1.0

by Multibilly on Sat Dec 05, 2015 11:14 am

MMFeb,

Only your doctor should comment on whether to continue treatment or not.

[Lev]

Re: Measuring M-spikes less than 1.0

by Lev on Sat Dec 05, 2015 10:50 pm

Hi MMfeb16,

Multibilly is of course 100% right, only ask your multiple myeloma specialist about whether you should take your prescribed treatment.

And only a few days ago you wrote

Since the last two months, after sixth and seven cycle of Revlimid plus dex, my M-spike is zero - not measurable. But in immunoelectrophoresis, kappa and IgG "suggestive monoclonal gammopathy - positive for IgG and kappa isotopes." My KFLCS is 27.1 mg/l (normal range 3.30 - 19.40), my K/L ratio and lambda is normal. My IgG was little above normal range after five cycles. Bone marrow biopsy was down to five to ten percent. My hematologist says it is not CR and continue Revlimid plus dex chemo one more month.

I would not stop treatment based on advice from anyone but an expert.

Best regards and good luck with your choice.

Best regards

Lev

[Multibilly]

Re: Measuring M-spikes less than 1.0

by Multibilly on Mon Dec 07, 2015 11:59 am

Coach Hoke,

BTW, the new Hevylite test appears to overcome the 1 g/dL accuracy limit of standard electrophoresis tests.

http://www.bindingsite.com/en/discover/freelite-and-hevylite/hevylite/laboratory-information/use-hevylite-when-monoclonal-protein-is-low

My understanding is that Labcorp now does the Hevylite test. So, even though one's local lab may not perform Hevylite testing, a serum sample can always be sent out to Labcorp for Hevylite processing. Alternatively, you can just drop into a Labcorp draw site (like I do) for routine testing.

[ninja performance]

Re: Measuring M-spikes less than 1.0

by ninja performance on Sun Feb 21, 2016 1:20 pm

When diagnosed in August 2011, I had an 8.9 g/dL M-spike, 85 to 90% bone marrow and 6.3 hgb.

Over the almost 5 years now, I have been with the same great hematologist/oncologist and office, and they have always been able to give me SPEP M-spike results under 1.0 g/dL.

I am currently refractory to Velcade, Revlimid, and Kyprolis. I'm now on daratumumab since September 2015, with M-spike drops of 0.1 every cycle (currently at 0.4). This Wednesday will be my second infusion since starting my once-a-month infusions. Same agent. I have had SPEP tests here in Monroe, North Carolina and at Johns Hopkins as low as 0.1.

[MMFeb16,15]

Re: Measuring M-spikes less than 1.0

by MMFeb16,15 on Fri Feb 26, 2016 6:58 pm

Thank you, Multibilly.

I understand these analysis and their needs better after reading your post. I am also able to interact with my two independent hematologists located at the main location where I am being treated and where I travel better.

I look forward to a CR or stable M-spike, Light chain test and serum immuno­electro­phoresis. I am not sure if I will need to go for bone marrow biopsy and PET scan.

In the last 18 months, I had three bone marrow biopsies and two PET scans.

I was scared when I was staged Stage II A IG kappa multiple myeloma. Now I am taking it as I have to live with it and manage it through modern medicines and diet.

Thank you again.