I am new to this forum. Please be patient reading my mother's story!
My mother (78 years old) has multiple myeloma since 2013 and had some initial treatment earlier.
She also had a pathological fracture in her left femur that required from her 3 surgeries to have it fixed. She has done an initial one; immediately after the fracture that was as an emergency case. That's why the nail fixation failed after 2 months. In October 2013, another surgery was done in Singapore with more proper nail fixation.
After surgery, her pain has reduced. They were expecting 3-6 months for the fracture to heal; which never happened due to lots of other factors: age, diabetics, multiple myeloma, etc.
Towards end of 2013, her multiple myeloma was in complete remission. We were told from the beginning that she is not a candidate for transplant due to lots of elements and mainly age.
She was put on a maintenance dose of Velcade 1.3 mg/m2 fortnightly + dexamethasone for almost a year (until February 2015). Despite the low dose she was given, she was able to achieve CR.
She became immobile, although she was very active before the fracture. Doctors after second surgery requested her not to walk or put any weight on it. Her mobility deteriorated, and she started getting pains in her legs and feet. We were told that is a side effect of the Velcade.
We decided to take her again to Singapore in April 2015 for another revision surgery; hip joint replacement which was the last resort.
The procedure went OK. However, she suffered a lot of post surgery problems. She was well managed but it took her around a month in the hospital till she was discharged. Just few days after returning back to the apartment in Singapore after discharge and before going back home (luckily) she made a wrong movement while trying to sit on the WC which caused the hip artificial ball to get dislocated!!
She was admitted again to hospital ... doctor managed to return the hip into its location externally without the need of going into another surgery. She stayed there around 2 weeks before getting discharged. She was in a very bad psychological state; so we did. Fortunately, they got her myeloma checked once again before leaving Singapore and her results were excellent:
FBC was normal, Hb was 11.8 g/dL
There was no monoclonal band detected and the immunoglobulin levels were normal (only IgM was below normal levels) . Her liver and renal functions were normal.
Her oncologist confirmed that she does not require any treatment at that time (although I have asked if a maintenance is required; he said no, only monitoring).
3 weeks ago, she has done the required routine tests. The results were as followed:
Unfortunately, as you can see, M-protein is 15.9 g/L (1.59 g/dL).
We did free light chain test. Results showed that both kappa and lambda are high. Hence, ratio is within the normal range. Doctor didn't comment much on that; although I have read somewhere in this forum that when both are high then it is not an indication for multiple myeloma!
Finally, doctor has performed a bone marrow test last week for her. She will see him this week to discuss the results.
Please give me your advice on the total situation, and about the recent results. Is there any indication from those results that myeloma could be active again?
Thank you.
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Your doctor (is your mother seeing a myeloma specialist?) is going to have the best idea of what to do. He/she may have her do a regimen that contains Velcade, perhaps tweaked with a different drug added in. Or they might go in a different direction entirely! Myeloma is a heterogenous disease, so I'm sure they will be looking closely at things like chromosomal abnormalities, past responses, etc.