[RickK]

New bone lesions while labs are normal?

by RickK on Sat Dec 27, 2014 12:08 am

Wondering if anyone has experienced new bone lesions while labs are absolutely normal?

I've just passed my second anniversary(s) of an auto and allo transplant, which produced a complete remission. I am currently on maintenance every other week (Velcade), and have experienced great results. Around Thanksgiving, however, I developed pain in one of my arms and mentioned it while at the clinic. They ordered X-rays and an MRI, which found a singular sarcoma.

My question: Has anyone experienced a bone lesion while having normal lab results? I'm starting radiation soon and could use hearing someone else's experiences.

Everyone be well,

Rick

[Cheryl G]

Re: New bone lesions while labs are normal?

by Cheryl G on Mon Dec 29, 2014 10:05 am

Hi Rick,

Unfortunately, it is possible for bone lesions to develop even when lab results show no M-spike or normal free light chain levels. This has come up a few times in the forum before.

See, for example, these discussions:

"New bone lesions, no change in blood work - relapse?", Beacon forum discussion started June 2, 2014.

"Relapse with low M-spike", Beacon forum discussion started May 25, 2011.

Dr. Siegel provides a very helpful explanation of how the situation can develop in the second discussion I linked to above. Here is what he says:

First, many patients with relatively low tumor burdens may have very focal disease that is capable of being locally destructive. Often patients will present in exactly such a fashion. They can have a local plasmacytoma that causes great harm with a bone marrow and tumor markers that are entirely negative. Sometimes when we treat multiple myeloma we will kill the diffuse disease but the local plasmacytoma will be more resistant and continue to grow, or progress more rapidly than the rest of the disease as we see a relapse. Many of us feel that we see that more often since the introduction of IMIDs [Revlimid, thalidomide, pomalidomide] than we did prior to that time.

Second are what we call oligosecretory relapses. This is disease that basically stops secreting, decreases its secretion of , or changes the nature of its M protein secretion. It is a very common problem to see a patient who made a big IgA or IgG "M" spike at presentation relapse with disease that only secretes a light chain. The "M" will go down in the blood while it is going up in the urine ("light chain escape").

Other times the multiple myeloma will stop making an "M" all together ("non­se­cre­tory escape"). As the tumor becomes more anaplastic with time and treatment it becomes less and less effecient at making its antibody (M protein). Anaplastic is a term that means the tumor becomes less and less like the original cell from which it was derived. Often in a newly diagnosed multiple myeloma pt the tumor cells will look like normal healthy plasma cells, but as the disease survives more and more therapies it becomes "angrier" and less able to perform its normal functions, of which secreting an intact antibody is but one."

I hope that, in your case, the radiation is able to take care of whatever myeloma may be at the lesion that was recently found.

Have your doctors considered treating you with something systemic, in addition to the radiation? It seems that, given that you've had an allo transplant, they might want to consider doing whatever they can to make sure this localized relapse does not spread and is controlled. They could either use some anti-myeloma therapies, such as Revlimid or Velcade or drugs similar to those, or perhaps do a donor lymphocyte infusion (DLI).

Good luck!

[RickK]

Re: New bone lesions while labs are normal?

by RickK on Thu Jan 01, 2015 11:39 pm

Cheryl,

Thanks for your response and the information. I am currently on Velcade maintenance every other weekend and have great results. One thing that is interesting: It is the same bone that I had a lesion on when I was diagnosed with multiple myeloma. I have had two radiation treatments at this point and the pain has reduced by 50%, which I am very happy with. I find that attitude is very important regardless of what gets thrown at you.

Thanks again,

Rick

[ericatuj]

Re: New bone lesions while labs are normal?

by ericatuj on Wed Jan 07, 2015 2:01 pm

Rick, my mother is in a similar situation. She had an auto and allo transplant last year and we just found out that one of her lesions has grown, although others have decreased or remained the same. However, her labs are all normal. We are wondering if this means a relapse, but have not had any clear answers yet. Her oncologist has recommended surgery to treat the new lesion and also Velcade maintenance.

Sorry if I was not helpful. But all the best to you!

Erica