Multibilly,
That is my understanding and is a good marker to determine if an existing patient has relapsed and should re-start or modify an existing treatment. As a practical matter I would think most oncologists would re-start or modify an existing treatment well before the sFLC numbers got to 100.
Ron
Forums
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: When do free light chain increases become an issue?
So quite a bit to go through here:
To the original post by Jet: An increase by 25% in the difference between the involved and uninvolved light chain meets criteria for "progressive disease." For simplicity, you can consider that an increase in your lambda by 25% (as your kappa was only 1). Roughly speaking, if your previous lambda light chain was 670 or lower, an increase to 900 would be at least a 25% increase. The goal would be to change or start new treatment to prevent further organ damage.
I am assuming that you had primarily light chain disease at the time of diagnosis – that is, no appreciable M-spike (monoclonal protein / paraprotein).
For Ron and Multibilly: The new light chain criteria apply to defining symptomatic multiple myeloma for newly diagnosed patients only. This is if the patients do not meet other CRAB criteria or the other new definitions of bone disease and bone marrow plasmacytosis of 60%.
To the original post by Jet: An increase by 25% in the difference between the involved and uninvolved light chain meets criteria for "progressive disease." For simplicity, you can consider that an increase in your lambda by 25% (as your kappa was only 1). Roughly speaking, if your previous lambda light chain was 670 or lower, an increase to 900 would be at least a 25% increase. The goal would be to change or start new treatment to prevent further organ damage.
I am assuming that you had primarily light chain disease at the time of diagnosis – that is, no appreciable M-spike (monoclonal protein / paraprotein).
For Ron and Multibilly: The new light chain criteria apply to defining symptomatic multiple myeloma for newly diagnosed patients only. This is if the patients do not meet other CRAB criteria or the other new definitions of bone disease and bone marrow plasmacytosis of 60%.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: When do free light chain increases become an issue?
Thank you so much all for your replies. I feel rather isolated with this, have no partner / husband to do the solid support. I'm really rather concerned that the haematologist hasn't been in touch 
Hi Melanie
You wrote:
I hope your husband is ok.
Multibilly
My last creatinine was on the 19th and was 76 umol/l (45-90). In November the local blood nurse got forms mixed up and there was no light chains done. As we speak, I only have light chain results for December and now CBC's. I have heard nothing from the haematologist that said ' We will monitor your blood results and let you know if there is cause for concern.'
Also, the huge drop in light chains at diagnosis over 2 days, what does that tell me? That these things can spike and fall randomly?
"What has your M-Spike been doing over this same period of time? (or is your multiple myeloma light-chain restricted and you have no M-spike?)" I dont know what this means and where to look for it on the blood tests.
At diagnosis, bone marrow exam showed 89% plasma cells.
I had 9 cycles of weekly CyBorD (Cytoxan, Velcade [bortezomib], dexamethasone) starting at diagnosis September 2013.
Hi Ron
Thanks for that info. When first diagnosed in September 2013, bone marrow examination showed 89% plasma cells.
When I first got diagnosed, my very first light chains blood test that my local doctor took was lambda 7025. Three days later I was hospitalized, where they of course did more bloods. The Lambda was 3470. I hadn't had ANY treatment in between.
At diagnosis, creatinine was 207 umol/l.
Anyone have any comment on that ?
Thanks all.
Hi Melanie
You wrote:
My husband's free lambda light chains at diagnosis were 7700, so I have no doubt in my mind that Jet is the test correctly. The concern with light chains that high is that they can interfere with kidney function. My husband's oncologist was amazed that my husband's kidney function had not been affected, therefore she worked very hard to get those numbers down quickly.
I hope your husband is ok.
Multibilly
My last creatinine was on the 19th and was 76 umol/l (45-90). In November the local blood nurse got forms mixed up and there was no light chains done. As we speak, I only have light chain results for December and now CBC's. I have heard nothing from the haematologist that said ' We will monitor your blood results and let you know if there is cause for concern.'
Also, the huge drop in light chains at diagnosis over 2 days, what does that tell me? That these things can spike and fall randomly?
"What has your M-Spike been doing over this same period of time? (or is your multiple myeloma light-chain restricted and you have no M-spike?)"
I dont know what this means and where to look for it on the blood tests.At diagnosis, bone marrow exam showed 89% plasma cells.
I had 9 cycles of weekly CyBorD (Cytoxan, Velcade [bortezomib], dexamethasone) starting at diagnosis September 2013.
Hi Ron
Thanks for that info. When first diagnosed in September 2013, bone marrow examination showed 89% plasma cells.
When I first got diagnosed, my very first light chains blood test that my local doctor took was lambda 7025. Three days later I was hospitalized, where they of course did more bloods. The Lambda was 3470. I hadn't had ANY treatment in between.
At diagnosis, creatinine was 207 umol/l.
Anyone have any comment on that ?
Thanks all.
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jet - Name: nzgirl
- Who do you know with myeloma?: me
- When were you/they diagnosed?: september 2013
- Age at diagnosis: 55
Re: When do free light chain increases become an issue?
Dr. Valent,
Thank you for clarifying the new criteria. I guess I just jumped to an assumption.
jet,
I think the Patient Handbook will help answer some of your questions.
http://myeloma.org/pdfs/Patient_Handbook_2013.pdf
The test that they run to determine the M spike is a Serum or Urine Protein Electrophoresis (SPEP) or (UPEP). Here is a booklet on that test:
http://myeloma.org/pdfs/U-PEP-Eng2012(P)_f1web.pdf
Good luck and hope you enjoy the holidays!
Ron
Thank you for clarifying the new criteria. I guess I just jumped to an assumption.
jet,
I think the Patient Handbook will help answer some of your questions.
http://myeloma.org/pdfs/Patient_Handbook_2013.pdf
The test that they run to determine the M spike is a Serum or Urine Protein Electrophoresis (SPEP) or (UPEP). Here is a booklet on that test:
http://myeloma.org/pdfs/U-PEP-Eng2012(P)_f1web.pdf
Good luck and hope you enjoy the holidays!
Ron
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: When do free light chain increases become an issue?
Hi Jason,
My most recent IgG (that's the m-spike yes??) was 16.
At diagnosis in September 2013:
IgG 103
Lambda 3470
Renal impairment 207
Beta2microglobulin 22.3mg/l
Thanks
My most recent IgG (that's the m-spike yes??) was 16.
At diagnosis in September 2013:
IgG 103
Lambda 3470
Renal impairment 207
Beta2microglobulin 22.3mg/l
Thanks
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jet - Name: nzgirl
- Who do you know with myeloma?: me
- When were you/they diagnosed?: september 2013
- Age at diagnosis: 55
Re: When do free light chain increases become an issue?
Hi Jet,
Your IgG level is not your M-spike (but an M-spike can effect the level of an immunogloblulin such as IgG). You will find your M-spike (aka M-protein, paraprotein, monoclonal protein, etc) on your Serum Protein Electrophoresis (SPEP) test.
BTW, it's helpful if you always include the units of measure and the normal reference levels from the lab tests. In your case, I'm guessing that an IgG level of "16" = 16 g/L, which in the USA would be represented as 1600 mg/dL (different labs and different regions of the world use different units of measure).
What is considered a "normal" IgG level can also vary from lab to lab. My lab considers 700-1600 mg/dL (7-16 g/L) to be normal.
Your IgG level is not your M-spike (but an M-spike can effect the level of an immunogloblulin such as IgG). You will find your M-spike (aka M-protein, paraprotein, monoclonal protein, etc) on your Serum Protein Electrophoresis (SPEP) test.
BTW, it's helpful if you always include the units of measure and the normal reference levels from the lab tests. In your case, I'm guessing that an IgG level of "16" = 16 g/L, which in the USA would be represented as 1600 mg/dL (different labs and different regions of the world use different units of measure).
What is considered a "normal" IgG level can also vary from lab to lab. My lab considers 700-1600 mg/dL (7-16 g/L) to be normal.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: When do free light chain increases become an issue?
We monitor disease in a number of ways after initial therapy. One is to monitor the disease burden using, for example, a patient's M-spike (serum/urine), immunoglobulin levels, and serum free light chain levels. Another is by checking for organ dysfunction through evidence that the multiple myeloma is again causing one or more of the "CRAB" symptoms – elevated calcium levels, kidney (renal) function, anemia, bone destruction, etc.
At relapse, we would like to avoid waiting until there are organ issues. So, if there is sign of organ dysfunction (CRAB+), then treatment. However, there is no perfect way to decide when to restart therapy without CRAB symptoms, even if, for example, a patient's M-spike has increased by 25%.
Generally, I would take into account the rate of serologic progression (how fast the M-spike or free light chains are increasing) and the relative size or the M-spike or involved free light chain level compared to the paraprotein / free light chain level at initial diagnosis, which was the level at which end organ dysfunction was noted. I would like to start well before we return to those levels, if possible. In addition, there are doctor and patient-specific tolerance / anxiety issues that play a role.
Some folks will slowly progress over a year or two, others need therapy right away secondary to rapid progression (even without new CRAB).
At relapse, we would like to avoid waiting until there are organ issues. So, if there is sign of organ dysfunction (CRAB+), then treatment. However, there is no perfect way to decide when to restart therapy without CRAB symptoms, even if, for example, a patient's M-spike has increased by 25%.
Generally, I would take into account the rate of serologic progression (how fast the M-spike or free light chains are increasing) and the relative size or the M-spike or involved free light chain level compared to the paraprotein / free light chain level at initial diagnosis, which was the level at which end organ dysfunction was noted. I would like to start well before we return to those levels, if possible. In addition, there are doctor and patient-specific tolerance / anxiety issues that play a role.
Some folks will slowly progress over a year or two, others need therapy right away secondary to rapid progression (even without new CRAB).
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
17 posts
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