Hi all -
I am curious about an aspect of my husband's recent results. He just finished his first 4 weeks of Darzalex While we are waiting the results of the serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IF) to see how effective this latest treatment has been, his Free Light Chain results are the following:
Kappa <1
Lambda <1
Ratio 1.00
He does not have nonsecretory myeloma and, although his free light chains have never been high, they have never been what looks to me as though they are undetectable.
Has Darzalex wiped out his M-spike and his healthy immunoglobulins?
Thanks for any help. I so appreciate this forum!
Laurie
Forums
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lwem - Name: Laurie
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 68
Re: No detectable free light chains during Darzalex?
Hi Laurie,
These figures don't look quite right.
1. Was this indeed a SERUM FREE light chain assay, or was it from a urine test or alternatively a serum light chain assay (i.e. not a serum FREE light chain assay)?
2. What are the units of measure? If these values were from a serum free light chain assay, and expressed in mg/L, the test should have measured the free light chain values down to the 1/10th's place. If these values were from a serum free light chain assay, and expressed in mg/dL, the test should have measured the free light chain values down to the the 1/100th's place.
These figures don't look quite right.
1. Was this indeed a SERUM FREE light chain assay, or was it from a urine test or alternatively a serum light chain assay (i.e. not a serum FREE light chain assay)?
2. What are the units of measure? If these values were from a serum free light chain assay, and expressed in mg/L, the test should have measured the free light chain values down to the 1/10th's place. If these values were from a serum free light chain assay, and expressed in mg/dL, the test should have measured the free light chain values down to the the 1/100th's place.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: No detectable free light chains during Darzalex?
Hi Laurie,
In addition to the great questions that Multibilly has raised, I would just point out that, if your husband's serum free light chain levels really have reached undetectable levels, this would not be the first time something like that has happened. See, for example, Mr. P's experience; if you look at the May 2017 free light chain levels he lists in this post, you'll see that they are at undetectable levels.
Mr. P also discusses how his free light chain levels stopped being undetectable in a separate forum thread:
"Free light chains no longer undetectable post transplant" (started Sep 9, 2017)
I suspect that what has happened with Mr P and (presumably) with your husband will be seen more regularly as Darzalex becomes used more and more frequently.
In addition to the great questions that Multibilly has raised, I would just point out that, if your husband's serum free light chain levels really have reached undetectable levels, this would not be the first time something like that has happened. See, for example, Mr. P's experience; if you look at the May 2017 free light chain levels he lists in this post, you'll see that they are at undetectable levels.
Mr. P also discusses how his free light chain levels stopped being undetectable in a separate forum thread:
"Free light chains no longer undetectable post transplant" (started Sep 9, 2017)
I suspect that what has happened with Mr P and (presumably) with your husband will be seen more regularly as Darzalex becomes used more and more frequently.
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JimNY
Re: No detectable free light chains during Darzalex?
JimNY and Multibilly:
Thank you both for your quick replies. Yes, this is the serum free light chain test. It is expressed in mg/L. I don't know why it is expressed as "<1" as opposed to an actual number.
I think this is good news, but my concern is that it looks like his healthy immunoglobulins also have been wiped out. I reread Mr. P's posts, and it seems as though his healthy immunoglobulins were indeed wiped out by the stem cell transplant and then came back after a few months.
My husband does not have light chain myeloma and he is not nonsecretory, just "regular" IgG kappa. He also has tp53 deletion and 1q21 amplification and a few other ugly lesions. So it would be great if just 4 weeks of Darzalex was actually this effective.
We will know the answer next week when we get the SPEP/IFE results, but I am anxious, so thought I would put it out there. Thank you again.
Laurie
Thank you both for your quick replies. Yes, this is the serum free light chain test. It is expressed in mg/L. I don't know why it is expressed as "<1" as opposed to an actual number.
I think this is good news, but my concern is that it looks like his healthy immunoglobulins also have been wiped out. I reread Mr. P's posts, and it seems as though his healthy immunoglobulins were indeed wiped out by the stem cell transplant and then came back after a few months.
My husband does not have light chain myeloma and he is not nonsecretory, just "regular" IgG kappa. He also has tp53 deletion and 1q21 amplification and a few other ugly lesions. So it would be great if just 4 weeks of Darzalex was actually this effective.
We will know the answer next week when we get the SPEP/IFE results, but I am anxious, so thought I would put it out there. Thank you again.
Laurie
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lwem - Name: Laurie
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 68
Re: No detectable free light chains during Darzalex?
Hi Iwem,
Tis may not be directly related to a lowering of the free light chains, but with the use of Darzalex, the tests to determine blood typing may be reduced. On the Janssen handout about Darzalex, this is said:
"Changes in blood tests. Darzalex can affect the results of blood tests to match your blood type. These changes can last for up to 6 months after your final dose of Darzalex. Your healthcare provider will do blood tests to match your blood type before you start treatment with Darzalex. Tell all of your healthcare providers that you are being treated with Darzalex before receiving blood transfusions."
I am not an immunologist, and do not know if there is any connection here, but maybe others would know about it.
Tis may not be directly related to a lowering of the free light chains, but with the use of Darzalex, the tests to determine blood typing may be reduced. On the Janssen handout about Darzalex, this is said:
"Changes in blood tests. Darzalex can affect the results of blood tests to match your blood type. These changes can last for up to 6 months after your final dose of Darzalex. Your healthcare provider will do blood tests to match your blood type before you start treatment with Darzalex. Tell all of your healthcare providers that you are being treated with Darzalex before receiving blood transfusions."
I am not an immunologist, and do not know if there is any connection here, but maybe others would know about it.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: No detectable free light chains during Darzalex?
Hi Nancy,
The impact that Darzalex in the blood has on a patient's myeloma labs is the opposite of what seems to be happening with Laurie's husband's test results.
Because Darzalex itself is a monoclonal antibody (immunoglobulin), it's presence in a patient's blood can lead to false positive serum immunofixation results, and it also can lead to falsely high M-spike readings.
However, because Darzalex is an intact monoclonal antibody, I would guess that its presence in the blood does not have any effect on a patient's FREE light chain levels, since free light chains are light chains that are not part of intact immunoglobulins (which consist of light chains and heavy chains bound to one another, rather than free from one another).
This study seems to confirm that Darzalex in the blood will not affect free light chain test results:
http://www.sciencedirect.com/science/article/pii/S0009912016301758?via%3Dihub
Obviously, because Darzalex is a myeloma therapy, it typically reduces a patient's M-spike and free light chain levels over time. What you've brought up, Nancy, and what I'm addressing is the complication that Darzalex introduces because it is a monoclonal antibody, and its mere presence in the blood can bias immunofixation and M-spike readings. There is a bit more about this topic in this forum thread:
https://myelomabeacon.org/forum/darzalex-m-protein-m-spike-t8870.html
The impact that Darzalex in the blood has on a patient's myeloma labs is the opposite of what seems to be happening with Laurie's husband's test results.
Because Darzalex itself is a monoclonal antibody (immunoglobulin), it's presence in a patient's blood can lead to false positive serum immunofixation results, and it also can lead to falsely high M-spike readings.
However, because Darzalex is an intact monoclonal antibody, I would guess that its presence in the blood does not have any effect on a patient's FREE light chain levels, since free light chains are light chains that are not part of intact immunoglobulins (which consist of light chains and heavy chains bound to one another, rather than free from one another).
This study seems to confirm that Darzalex in the blood will not affect free light chain test results:
http://www.sciencedirect.com/science/article/pii/S0009912016301758?via%3Dihub
Obviously, because Darzalex is a myeloma therapy, it typically reduces a patient's M-spike and free light chain levels over time. What you've brought up, Nancy, and what I'm addressing is the complication that Darzalex introduces because it is a monoclonal antibody, and its mere presence in the blood can bias immunofixation and M-spike readings. There is a bit more about this topic in this forum thread:
https://myelomabeacon.org/forum/darzalex-m-protein-m-spike-t8870.html
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JimNY
Re: No detectable free light chains during Darzalex?
Thanks Jim.
The article you posted from the journal Clinical Biochemistry shows a study that infers that Darzalex does not interfere with serum free light chains in the blood. I don't think that would have anything to do with blood typing. Interesting that daratumumab is an IgG monoclonal antibody, and thus can show false positives for the 'M' protein, though. Is this drug used for patients with other immunoglobulins in the 'M' spike, such as IgA, IgM, etc., or are there other monoclonal antibody treatments for those patients?
The article you posted from the journal Clinical Biochemistry shows a study that infers that Darzalex does not interfere with serum free light chains in the blood. I don't think that would have anything to do with blood typing. Interesting that daratumumab is an IgG monoclonal antibody, and thus can show false positives for the 'M' protein, though. Is this drug used for patients with other immunoglobulins in the 'M' spike, such as IgA, IgM, etc., or are there other monoclonal antibody treatments for those patients?
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: No detectable free light chains during Darzalex?
Hi Jim and Nancy,
I do know about the blood typing issues and the potential impact on the M-spike with Darzalex. I suppose that it's possible that it interferes with the free light chain assay as well in some odd way.
We will see the doctor at the end of the week. Hopefully we will have news from the SPEP/IFE and I will ask our doctor about the free light chain results. I just can't figure out anything other than it must have wiped out his M-protein and his healthy immunoglobulins as well.
Thank you all for your thoughts and suggestions.
Laurie
I do know about the blood typing issues and the potential impact on the M-spike with Darzalex. I suppose that it's possible that it interferes with the free light chain assay as well in some odd way.
We will see the doctor at the end of the week. Hopefully we will have news from the SPEP/IFE and I will ask our doctor about the free light chain results. I just can't figure out anything other than it must have wiped out his M-protein and his healthy immunoglobulins as well.
Thank you all for your thoughts and suggestions.
Laurie
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lwem - Name: Laurie
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 68
Re: No detectable free light chains during Darzalex?
Hi Laurie and Nancy,
Even though Darzalex is an IgG kappa antibody, this does not mean it can be used to treat only myeloma patients with IgG kappa multiple myeloma. I have not seen anything to suggest its efficacy is any different, for example, in patients with IgA kappa myeloma, or IgG lambda myeloma, etc.
Even though Darzalex is an IgG kappa antibody, this does not mean it can be used to treat only myeloma patients with IgG kappa multiple myeloma. I have not seen anything to suggest its efficacy is any different, for example, in patients with IgA kappa myeloma, or IgG lambda myeloma, etc.
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JimNY
Re: No detectable free light chains during Darzalex?
Hello Laurie,
Between week three and four of Darzalex, my spouse’s kappa and lambda free light chain levels were “undetectable.” Hence, a ratio could not be calculated. It's my understand that low concentrations of kappa, lambda, or both, are indicative of bone marrow suppression.
Most interesting, on a separate note, the ANC was below 500. Since ANC was below 500, week four Darzalex treatment was suspended until the following week. Being kept in isolation at home, to avoid any “bugs and germs” that are being passed around the general population.
The WBC, RBC, platelets, etc. have always been low or abnormally low, on previous treatment, and this current treatment.
There was decrease seen in the paraprotein (M-spike) upon completion of three weeks of treatment; however, were advised by the hematologist-oncologist to not place “too much energy” into any results until after eight weeks, or so, of starting the Darzalex treatment.
This fits with what is in the FDA-approved prescribing information for Darzalex,. For the three-drug regimen my spouse is on (Darzalex, Pomalyst, and dexamethasone), the prescribing information (section 14.3) says:
"The median time to response was 1 month (range: 0.9 to 2.8 months). The median duration of response was 13.6 months (range: 0.9+ to 14.6+ months)."
For Darzalex as monotherapy, the prescribing information (section 14.4) says:
"The median time to response was 1 month (range: 0.9 to 5.6 months). The median duration of response was 7.4 months (range: 1.2 to 13.1+ months)."
Hope this helps? You are not alone!
Best to you,
Zelda
Between week three and four of Darzalex, my spouse’s kappa and lambda free light chain levels were “undetectable.” Hence, a ratio could not be calculated. It's my understand that low concentrations of kappa, lambda, or both, are indicative of bone marrow suppression.
Most interesting, on a separate note, the ANC was below 500. Since ANC was below 500, week four Darzalex treatment was suspended until the following week. Being kept in isolation at home, to avoid any “bugs and germs” that are being passed around the general population.
The WBC, RBC, platelets, etc. have always been low or abnormally low, on previous treatment, and this current treatment.
There was decrease seen in the paraprotein (M-spike) upon completion of three weeks of treatment; however, were advised by the hematologist-oncologist to not place “too much energy” into any results until after eight weeks, or so, of starting the Darzalex treatment.
This fits with what is in the FDA-approved prescribing information for Darzalex,. For the three-drug regimen my spouse is on (Darzalex, Pomalyst, and dexamethasone), the prescribing information (section 14.3) says:
"The median time to response was 1 month (range: 0.9 to 2.8 months). The median duration of response was 13.6 months (range: 0.9+ to 14.6+ months)."
For Darzalex as monotherapy, the prescribing information (section 14.4) says:
"The median time to response was 1 month (range: 0.9 to 5.6 months). The median duration of response was 7.4 months (range: 1.2 to 13.1+ months)."
Hope this helps? You are not alone!
Best to you,
Zelda
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ZippyZelda - Name: ZippyZelda
- Who do you know with myeloma?: Spouse
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