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Most important variable in calculating remission?
I'm confused. Which is the most critical/accurate metric in calculating remission: monoclonal protein or percent of plasma cells (as determined by flow cytometry). Just completed five cycles of VTD. Plasma fell from 20% to 0.006. That's 99+% remission! However, my M protein fell only from 1.6 to .28 an 80% drop. Which if either is most accurate--or is there another metric I'm unaware of? Can I expect to get that protein number down even lower with a SCT in a couple of weeks? Thanks.
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colville
Re: Most important variable in calculating remission?
At the end of the day, regardless of the metric you use, you have had an excellent initial response to treatment!
I would argue that the M protein determination trumps the burden of plasma cells on biopsy, especially as measured by flow cytometry, but the various tests we use do complement one another. The marrow involvement with myeloma can be patchy and differ substantially from one area to the next. As such, sampling error is a problem. Additionally, flow cytometry samples from bone marrow aspirates are often diluted with peripheral blood (which contains far fewer myeloma cells). Thus, flow cytometry can underestimate the burden of disease, depending on the extent of peripheral blood dilution of the sample. The M protein represents an average of your body's disease burden and is not subject to these pitfalls.
Once again, you have had a great response, and yes, you can expect the M protein to improve with transplant.
Good luck with the next steps!
Pete V.
I would argue that the M protein determination trumps the burden of plasma cells on biopsy, especially as measured by flow cytometry, but the various tests we use do complement one another. The marrow involvement with myeloma can be patchy and differ substantially from one area to the next. As such, sampling error is a problem. Additionally, flow cytometry samples from bone marrow aspirates are often diluted with peripheral blood (which contains far fewer myeloma cells). Thus, flow cytometry can underestimate the burden of disease, depending on the extent of peripheral blood dilution of the sample. The M protein represents an average of your body's disease burden and is not subject to these pitfalls.
Once again, you have had a great response, and yes, you can expect the M protein to improve with transplant.
Good luck with the next steps!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Most important variable in calculating remission?
Thanks Dr. Voorhees. We appreciate the clarification.
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Colville
Re: Most important variable in calculating remission?
How does M Protein show up on test results or reports? I don't see anything labeled M Protein on the reports. Our oncologist seems to only be relying on Light Chains and their reduction. What are we missing?
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LadyLib - Name: LadyLib
- Who do you know with myeloma?: Spouse
- When were you/they diagnosed?: July 2013
- Age at diagnosis: 42
Re: Most important variable in calculating remission?
Hi LadyLib, in the majority of patients (80%) it will show up on the SPEP----serum electropheresis---as an M Spike. It can also be detected with serum immunofixation which can be done concurrently with the SPEP.The IFE detects but does not quantify the M protein. It can also be detected in the urine, usually after a 24 hour collection. In about 20 % of patients, who are light chain only like me, the SPEP's are usually normal. Our disease is primarily tracked by the light chain assay. Is your husband light chain only?
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: Most important variable in calculating remission?
I am not sure if he is Light Chain only. Our oncologist has not explained all of that thoroughly, nor did we ask initially. He gets everything checked weekly (not urine) and gets the Light Chains checked every 4 weeks. So far his light chains have been 518 at diagnosis, 73 after 4 weeks and 28 after 8 weeks. They told him to prep for SCT, he would need to do a 24 hour urine and Bone Marrow Biopsy, so maybe his urine is important?
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LadyLib - Name: LadyLib
- Who do you know with myeloma?: Spouse
- When were you/they diagnosed?: July 2013
- Age at diagnosis: 42
Re: Most important variable in calculating remission?
Tests for M-spike are not done every time you have a blood test, but they are done periodically to assess where you are. When EJ had his initial therapy for multiple myeloma, his M-spike was tested after round 3 of Velcade/dex, and then again after round 6 as he was preparing for his SCT. Now, it is tested every three months. On his lab results his m-spike is labeled as "paraprotein." Hope that helps.
Carolyn
Carolyn
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Christa's Mom - Name: Christa's Mom
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: September, 2010
- Age at diagnosis: 53
Re: Most important variable in calculating remission?
I imagine each doctor is different. Mine checks for light chains and M1,2,3 every 3 months. They are all important, but some more than others I would imagine. For me , with Bence Jones, the Lambda is very important and the ratio between it and Kappa also important.
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Wayne K - Name: Wayne
- Who do you know with myeloma?: Myself, my sister who passed in '95
- When were you/they diagnosed?: 03/09
- Age at diagnosis: 70
Re: Most important variable in calculating remission?
On some of my lab reports the m spike is reported as "abnormal protein 1" . Other formats of my labs actually say m spike.
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torimooney - Name: tori
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: apr 2012
- Age at diagnosis: 64
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