Hello everyone,
A bone marrow biopsy done after I relapsed one year and four months after my successful autologous stem cell transplant revealed a new strain of myeloma.
My oncologist told me that this kind of event was not unusual, and was probably due to DNA damage from the melphalan infusion that was part of the transplant process.
I have not ever heard of this sort of thing happening. Is it very common? The pathologist described this development as “adverse” in the biopsy report.
Forums
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
Re: New strain of myeloma due to stem cell transplant?
I am not sure what you mean by a "different strain." If you mean that you went from, for example, IgG kappa to IgG lambda, then do a search for "secondary MGUS" and "atypical serum immunofixation pattern."
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: New strain of myeloma due to stem cell transplant?
Hi Andrew,
You may be right in that Mr. PH developed a different isotype of disease post-transplant (which certainly does happen, as you clearly stated).
But given the oncologist's comments about DNA damage and the results being "adverse", I'm guessing that the before-and-after iFISH results suggested that he might now have a different makeup of myeloma cells with different chromosomal abnormalities (i.e. del 17p, t(11, 14), trisomies, etc.).
Mr. PH, did the doctor offer any specific insight into what has changed? It sounds plausible to me as a layman that the melphalan may have been the culprit. But I could also see a situation where the transplant knocked out some but not all of the original clonal lines, only to allow other clonal lines to gain traction, evolve and / or dominate in your bone marrow.
You may be right in that Mr. PH developed a different isotype of disease post-transplant (which certainly does happen, as you clearly stated).
But given the oncologist's comments about DNA damage and the results being "adverse", I'm guessing that the before-and-after iFISH results suggested that he might now have a different makeup of myeloma cells with different chromosomal abnormalities (i.e. del 17p, t(11, 14), trisomies, etc.).
Mr. PH, did the doctor offer any specific insight into what has changed? It sounds plausible to me as a layman that the melphalan may have been the culprit. But I could also see a situation where the transplant knocked out some but not all of the original clonal lines, only to allow other clonal lines to gain traction, evolve and / or dominate in your bone marrow.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: New strain of myeloma due to stem cell transplant
Thank you, Andrew and Multibilly,
The cytogenetics analysis section of the biopsy report indicated that I now have, in addition to the normal karyotype that characterized all of the myeloma cells found during my previous two biopsies, some hyperdiploid cells showing an abnormal male karyotype. The latter cells were also characterized as having multiple chromosomal additions and deletions, indicating a second “malignant” clone whose complexities point to an “adverse prognosis.”
In addition, for the first time, there is now a faint IgG M-spike detected by electrophoresis and immunofixation tests, in addition to the free kappa light chains that have been present since my diagnosis back in 2015.
I assume that the newly found hyperdiploid clone is probably the source of the M-spike.
The cytogenetics analysis section of the biopsy report indicated that I now have, in addition to the normal karyotype that characterized all of the myeloma cells found during my previous two biopsies, some hyperdiploid cells showing an abnormal male karyotype. The latter cells were also characterized as having multiple chromosomal additions and deletions, indicating a second “malignant” clone whose complexities point to an “adverse prognosis.”
In addition, for the first time, there is now a faint IgG M-spike detected by electrophoresis and immunofixation tests, in addition to the free kappa light chains that have been present since my diagnosis back in 2015.
I assume that the newly found hyperdiploid clone is probably the source of the M-spike.
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
Re: New strain of myeloma due to stem cell transplant
MrPotatohead wrote:
MrPotatohead,
The Empliciti you’re getting now is in fact an IgG kappa antibody, so that faint IgG M-spike they see in your lab results is probably just Empliciti and not a real new clone.
I have IgA lambda multiple myeloma and since after relapse I started an Empliciti, Revlimid, and dexamethasone (ERd) regimen, there are two bands in my lab results: IgA lambda, and IgG kappa, and the second one is just due to Empliciti.
In addition, for the first time, there is now a faint IgG M-spike detected by electrophoresis and immunofixation tests, in addition to the free kappa light chains that have been present since my diagnosis back in 2015.
I assume that the newly found hyperdiploid clone is probably the source of the M-spike.
MrPotatohead,
The Empliciti you’re getting now is in fact an IgG kappa antibody, so that faint IgG M-spike they see in your lab results is probably just Empliciti and not a real new clone.
I have IgA lambda multiple myeloma and since after relapse I started an Empliciti, Revlimid, and dexamethasone (ERd) regimen, there are two bands in my lab results: IgA lambda, and IgG kappa, and the second one is just due to Empliciti.
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borber - Name: borber
- Who do you know with myeloma?: me
- When were you/they diagnosed?: January, 2017
- Age at diagnosis: 60
Re: New strain of myeloma due to stem cell transplant?
Thank you, borber
Now that would never had occurred to me!
I naturally assumed the worst, which is an unfortunate tendency I have.
I appreciate your sharing this with me very much.
Now that would never had occurred to me!
I naturally assumed the worst, which is an unfortunate tendency I have.
I appreciate your sharing this with me very much.
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
Re: New strain of myeloma due to stem cell transplant?
That was a nice catch by Borber.
There is now an assay available through Labcorp and Quest Diagnostics that uses a special reagent (Hydrashift 2/4 daratumumab) that can compensate for Darzalex itself throwing off serum electrophoresis and immunofixation results. However, I am not aware of a similar lab test that does this sort of compensation for Empliciti.
There is now an assay available through Labcorp and Quest Diagnostics that uses a special reagent (Hydrashift 2/4 daratumumab) that can compensate for Darzalex itself throwing off serum electrophoresis and immunofixation results. However, I am not aware of a similar lab test that does this sort of compensation for Empliciti.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: New strain of myeloma due to stem cell transplant?
Yes, it was indeed a nice catch.
Here is what the pathologist actually wrote:
“Very faint IgG-kappa identified”
And yet when I brought it to my oncologist’s attention, he disagreed. He said the faint spike was in fact caused by my myeloma, even though this is the first time in almost five years I have shown any M spike.
But I still think borber is right. I found this in the Empliciti prescribing information:
"Empliciti is a humanized IgG kappa monoclonal antibody that can be detected on both the serum protein electrophoresis (SPEP) and immunofixation (IFE) assays used for the clinical monitoring of endogenous M-protein. This interference can impact the determination of complete response and possibly relapse from complete response in patients with IgG kappa myeloma protein".
Here is what the pathologist actually wrote:
“Very faint IgG-kappa identified”
And yet when I brought it to my oncologist’s attention, he disagreed. He said the faint spike was in fact caused by my myeloma, even though this is the first time in almost five years I have shown any M spike.
But I still think borber is right. I found this in the Empliciti prescribing information:
"Empliciti is a humanized IgG kappa monoclonal antibody that can be detected on both the serum protein electrophoresis (SPEP) and immunofixation (IFE) assays used for the clinical monitoring of endogenous M-protein. This interference can impact the determination of complete response and possibly relapse from complete response in patients with IgG kappa myeloma protein".
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
Re: New strain of myeloma due to stem cell transplant?
Well, it does turn out that my oncologist was correct in my case, the very small M-spike is in fact due to multiple myeloma, not Empliciti. So even though I originally was diagnosed with kappa light chain multiple myeloma, I now also have an M-spike, but a very faint one (so far, at least).
Apparently this is not common, but it does happen.
Apparently this is not common, but it does happen.
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
Re: New strain of myeloma due to stem cell transplant?
Hi Mr PH,
How would your oncologist know that this new, faint spike was due to myeloma and not Empliciti?
How would your oncologist know that this new, faint spike was due to myeloma and not Empliciti?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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