Hi.
I was diagnosed in December 2016. I have multiple myeloma with normal risk cytogenetics. After my diagnosis, I enrolled in a clinical trial and was placed on Velcade, Revlimid, and dexamethasone (VRD) for 10 months. I did well, with my M-spike going to zero and bone marrow biopsy in September being minimal residual disease (MRD) negative. I always remained immunofixation electrophoresis (IFE) positive for IgG kappa, which was my original clone. In the trial, I was randomized after my induction therapy to indefinite Revlimid (15 mg). I have been on this for 2 months.
My most recent labs showed a return of the M-spike of 0.04 g/dL and my IFE is still positive for kappa.
How can I have these small signs of myeloma if I was just found to be MRD negative in September. What does it mean? Am I relapsing? Is the recent MRD testing more predictive than the blood labs?
Grateful for any thoughts.
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Benny - Name: BM1971
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 12/2/16
- Age at diagnosis: 45
Re: MRD & blood test results don't agree: what's it mean?
Hi Benny,
I am guessing the MRD test you used was a flow cytometry test done from a bone marrow sample since that is the most common way to test for MRD currently. If that is the case, than all that shows is that the sample they took from that specific spot did not have any myeloma detectable within the sensitivity of that test. Myeloma is a "patchy" disease. If they had taken the sample from another place, it could have tested positive. It is not uncommon for a patient to have signs of disease in their blood work or on an imaging test but test MRD negative. Typically sustained MRD negativity – testing done on different dates and from different spots – is considered a positive prognostic indicator. One MRD negative test would not be considered all that significant.
MRD testing is typically used for research purposes for myeloma patients. Since you and your doctors probably are not using the results of the MRD test to make a therapy decision, I would not put that much emphasis on the result of the MRD test. Your doctors most likely will focus on the blood tests to determine if you need to change therapy. Many (probably most) myeloma patients never have an MRD test done.
Best of luck moving forward. Hopefully the next test will show the M-spike back to zero.
Mark
I am guessing the MRD test you used was a flow cytometry test done from a bone marrow sample since that is the most common way to test for MRD currently. If that is the case, than all that shows is that the sample they took from that specific spot did not have any myeloma detectable within the sensitivity of that test. Myeloma is a "patchy" disease. If they had taken the sample from another place, it could have tested positive. It is not uncommon for a patient to have signs of disease in their blood work or on an imaging test but test MRD negative. Typically sustained MRD negativity – testing done on different dates and from different spots – is considered a positive prognostic indicator. One MRD negative test would not be considered all that significant.
MRD testing is typically used for research purposes for myeloma patients. Since you and your doctors probably are not using the results of the MRD test to make a therapy decision, I would not put that much emphasis on the result of the MRD test. Your doctors most likely will focus on the blood tests to determine if you need to change therapy. Many (probably most) myeloma patients never have an MRD test done.
Best of luck moving forward. Hopefully the next test will show the M-spike back to zero.
Mark
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Mark11
Re: MRD & blood test results don't agree: what's it mean?
Hi,
So I got my next month's M-spike yesterday. Now its 0.04 g/dL (0.4 g/l) two months in a row after being zero all summer. So I guess I am wondering what it all means. I was in a complete response for about 8 weeks but now I have this small persistent M-spike. Is this the beginning of a relapse already? Can you have a minuscule M-spike that appears and just hangs out and stays low?
So I got my next month's M-spike yesterday. Now its 0.04 g/dL (0.4 g/l) two months in a row after being zero all summer. So I guess I am wondering what it all means. I was in a complete response for about 8 weeks but now I have this small persistent M-spike. Is this the beginning of a relapse already? Can you have a minuscule M-spike that appears and just hangs out and stays low?
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Benny - Name: BM1971
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 12/2/16
- Age at diagnosis: 45
Re: MRD & blood test results don't agree: what's it mean?
After my stem cell transplant, I was a zero for maybe 6 weeks. After that, I have usually been a 0.2 or 0.3, and it has been that way for 3 years. My last test results said 0.9, and my IgA doubled, but my kappa-lambda ratio is still in normal limits.
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kjpoppit - Name: Kim Nelson
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Sept. 19th, 2013
- Age at diagnosis: 47
Re: MRD & blood test results don't agree: what's it mean?
Hello Benny,
Yes, you can have a low M-spike and just hang out and stay low. I was diagnosed In January 2013 and after a failed autologous stem cell transplant in October of 2014 I was started on Kyprolis and dexamethasone in February of 2015. After 3 years, I’m still on Kyprolis and dex and my M-spike has been at 0.4 g/liter since July of 2015. I feel good, I tolerate treatment very well, and my myeloma specialist said he sees no reason or need to achieve a lower M-spike. We do an SPEP and UPEP every 90 days, and treatment is monitored with a CBC and metabolic panel every two weeks. Our goal is to maintain progression free survival with continuous treatment that’s well tolerated. Good quality of life does not necessarily mean you must achieve a zero M-spike or be MRD negative. All the best to you.
Yes, you can have a low M-spike and just hang out and stay low. I was diagnosed In January 2013 and after a failed autologous stem cell transplant in October of 2014 I was started on Kyprolis and dexamethasone in February of 2015. After 3 years, I’m still on Kyprolis and dex and my M-spike has been at 0.4 g/liter since July of 2015. I feel good, I tolerate treatment very well, and my myeloma specialist said he sees no reason or need to achieve a lower M-spike. We do an SPEP and UPEP every 90 days, and treatment is monitored with a CBC and metabolic panel every two weeks. Our goal is to maintain progression free survival with continuous treatment that’s well tolerated. Good quality of life does not necessarily mean you must achieve a zero M-spike or be MRD negative. All the best to you.
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Dano - Who do you know with myeloma?: Me
- When were you/they diagnosed?: Jan 2014
- Age at diagnosis: 65
Re: MRD & blood test results don't agree: what's it mean?
I'm wondering the same sort of thing as Benny.
A family member of mine has just finished his induction therapy with Revlimid, Velcade, and dexamethasone before an autologous stem cell transplant (ASCT). Over the course of 5 cycles, his M-spike dropped from 7.3 to 0.5 g/dL, and his kappa light chain dropped from 1100 to 30. From the blood work, we concluded that he had achieved a very good partial response.
Just this week, we got test results back from his minimal residual disease (MRD) flow exam and the result was staggeringly low. Just 0.0029% of his bone marrow from the sample was detected to be abnormal plasma. His initial bone marrow biopsy had about 50% abnormal plasma.
What I don't understand is how his residual disease level in his bone marrow can be so low right now, but he still has M protein and a slightly abnormal kappa light chain.
Could it be in the two weeks between his last blood work and bone marrow biopsy that his results dropped to a CR level response? Could the bone marrow biopsy be inaccurate? Maybe the sample came from an area that didn't have many myeloma cells compared to other parts of his body.
I am setting up a meeting with the doctor to ask a lot of these questions but I was hoping I could get some other perspectives just to be more knowledgeable.
Thank you in advance.
A family member of mine has just finished his induction therapy with Revlimid, Velcade, and dexamethasone before an autologous stem cell transplant (ASCT). Over the course of 5 cycles, his M-spike dropped from 7.3 to 0.5 g/dL, and his kappa light chain dropped from 1100 to 30. From the blood work, we concluded that he had achieved a very good partial response.
Just this week, we got test results back from his minimal residual disease (MRD) flow exam and the result was staggeringly low. Just 0.0029% of his bone marrow from the sample was detected to be abnormal plasma. His initial bone marrow biopsy had about 50% abnormal plasma.
What I don't understand is how his residual disease level in his bone marrow can be so low right now, but he still has M protein and a slightly abnormal kappa light chain.
Could it be in the two weeks between his last blood work and bone marrow biopsy that his results dropped to a CR level response? Could the bone marrow biopsy be inaccurate? Maybe the sample came from an area that didn't have many myeloma cells compared to other parts of his body.
I am setting up a meeting with the doctor to ask a lot of these questions but I was hoping I could get some other perspectives just to be more knowledgeable.
Thank you in advance.
Re: MRD & blood test results don't agree: what's it mean?
MRD test results and myeloma lab results do not have to match up, especially in the short term.
As Multibilly pointed out in a reply to a previous question you asked, immunoglobulin molecules have long half lives in the body, like 3 or more weeks. So even if a person's myeloma were to be suddenly wiped out completely (yay!), it would take a month or more for their M-spike to drop to low levels.
Also, as is pointed out regularly here in the forum in discussions of bone marrow biopsies, myeloma often is a "patchy" disease, so what you find with a bone marrow biopsy in one part of the body can be different than what you would find if you did a biopsy in another part of the body.
Not only that, but the myeloma in a patient's body can vary throughout the body in terms of its responsiveness to treatment. There may be patches of disease in a patient's spine, for example, that respond better to therapy than the disease in a patient's femur, or vice versa.
The broader point is that myeloma lab results won't always change in lockstep with one another, and you need to look at the total picture they paint and how it's changing to get the best sense of what is happening to the disease, including how it is responding to treatment.
As Multibilly pointed out in a reply to a previous question you asked, immunoglobulin molecules have long half lives in the body, like 3 or more weeks. So even if a person's myeloma were to be suddenly wiped out completely (yay!), it would take a month or more for their M-spike to drop to low levels.
Also, as is pointed out regularly here in the forum in discussions of bone marrow biopsies, myeloma often is a "patchy" disease, so what you find with a bone marrow biopsy in one part of the body can be different than what you would find if you did a biopsy in another part of the body.
Not only that, but the myeloma in a patient's body can vary throughout the body in terms of its responsiveness to treatment. There may be patches of disease in a patient's spine, for example, that respond better to therapy than the disease in a patient's femur, or vice versa.
The broader point is that myeloma lab results won't always change in lockstep with one another, and you need to look at the total picture they paint and how it's changing to get the best sense of what is happening to the disease, including how it is responding to treatment.
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