[dianaiad]

multiple myeloma without light chains

by dianaiad on Sat Aug 17, 2013 11:02 am

I've just been given homework (My oncologist has finally figured out how to 'deal' with me..grin) to find out why my version of multiple myeloma doesn't show light chains. That is, when the original tests to diagnose me were done, no extra light chains were seen, even though I was stage II, with 70% plasma cell in the bone marrow. I'm also 'high risk,' with the p-17 deletion.

My blood tests simply do not show extra light chains. Where can I go to find out how many multiple myeloma patients have this variation, and possibilities for why?

[Dr. Ken Shain]

Re: multiple myeloma without light chains

by Dr. Ken Shain on Sun Aug 18, 2013 7:28 am

It is rare with contemporary tools to find truly non-secretory multiple myeloma- meaning no quantitative assessment of monoclonal paraprotein; no s M-spikem, urine M spike or SFLC. Though is does occur probably at a rate of 1-2%- 2% when quoting literature (Kyle et al Mayo Clinic Proc 2003 p21) or in most myeloma revews. It does make things a bite more difficult in terms of monitoring your disease as there are no serum or urine markers to following the success of therapy or at the time of relapse. The why: although myeloma is a disease of plasma cells- cells whose sole job is to make antibodies- there are malignant and therefore do no always make the complete antibody or secrete into the circulation. Some myeloma secretes only light chains, some the entire antibody, and as in your case no antibodies.

Have you undergone a PET/CT? In addition to standard myeloma imaging I always order PET/CT on patients with non-secretory multiple myeloma. Generaly, 70% of multiple myeloma patients are also PET+ in the bone marrow and this gives us a measurement or quantification of disease burden; thus, something to monitor throughout the disease course.

With the finding of deletion 17p- as you noted high risk- please ensure that you have Bortezomib (Velcade) as part of your induction/primary therapy.

Best of luck.