My husband was diagnosed in July of 2014. At the time of diagnosis, his lambda light chains were 3692 g/dl. When he started his RVD (Revlimid, Velcade, dexamethasone) therapy on August 4th, his light chains had risen to 7700.
His first cycle of RVD cut his light chains by more than half and we were excited and very encouraged. After that cycle, his light chains bounced around during the subsequent cycles. One cycle they would be up slightly, then go down dramatically, then would once again make a dramatic move upwards.
Finally his oncologist put him in the hospital for a 4-day round of DR-PACE (dexamethasone, Revlimid, cisplatin, doxorubicin, and etoposide). On admission to the hospital for the chemo his light chains were 3490, and then upon discharge 4 days later, his light chains had been lowered to 1670. However, when they did another light chain test on December 1st, his light chains were already on their way back up with a reading of 2320. Finally, his oncologist referred us to a specialist.
Specialist ran a serum free light chain test and the results of that was 5594. His B2M was 6.34 and his C-reactive protein was 39.7. Husband had his first cycle of Kyprolis, Cytoxan (cyclophosphamide) and dex and that regimen brought his light chains down to 2721.
Husband did second cycle of Kyprolis, Cytoxan, and dex. Now the lab for whatever reason decided to run his myeloma markers the morning of the day he was receiving his last dose of that cycle before he even received the chemo. The results of that his light chains had risen to 2849.
We called the specialist and he had my husband come in before the start of his third cycle to run the entire myeloma panel again. This time, his light chains came down to 2589. His B2M came down to 4.53.
We were happy his light chains came down even if it was not by that much. One thing that did concern me was his C-reactive protein result. As I said earlier, on December 10, the reading was 39.7, however on February 7th the reading was 67.3.
This has me extremely concerned in that, from the research I have done, the CRP seems to protect the myeloma cells from the chemo, which has me wondering if once again he will become refractory to Kyprolis, Cytoxan and dex.
Specialist wanted to try and get my husband's light chains down below 1000 before he harvested his stem cells, but with this turn of events I am wondering if they will even get them down that low.
Forums
8 posts
• Page 1 of 1
-
Melanie - Name: Melanie
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: July 2014
- Age at diagnosis: 54
Re: Significance of the C-reactive protein test?
Hello Melanie,
Your husband certainly has been through a lot. I hope that he continues to respond to the Kyprolis, cyclophosphamide, and dex.
You mention your husband C-reactive protein levels for two of the times he got blood tests, but there were several times when you gave his lambda free light chain results but no C-reative protein results.
I've put together a table below that lists the results you gave with dates.
It might help make sense of the C-reactive protein results if you could give us the levels for the tests for those dates where you've given the lambda free light chain levels.
Date Lambda CRP
FLC
Jul 2014 3692 ?
Aug 4, 2014 7700 ?
Before DR-PACE 3490 ?
After DR-PACE 1670 ?
Dec 1, 2014 2320 ?
Dec 10, 2014 5594 39.7
After 1st cycle KCD 2721 ?
End of 2nd cycle KCD 2849 ?
Feb 7, 2015 2589 67.3
Your husband certainly has been through a lot. I hope that he continues to respond to the Kyprolis, cyclophosphamide, and dex.
You mention your husband C-reactive protein levels for two of the times he got blood tests, but there were several times when you gave his lambda free light chain results but no C-reative protein results.
I've put together a table below that lists the results you gave with dates.
It might help make sense of the C-reactive protein results if you could give us the levels for the tests for those dates where you've given the lambda free light chain levels.
Date Lambda CRP
FLC
Jul 2014 3692 ?
Aug 4, 2014 7700 ?
Before DR-PACE 3490 ?
After DR-PACE 1670 ?
Dec 1, 2014 2320 ?
Dec 10, 2014 5594 39.7
After 1st cycle KCD 2721 ?
End of 2nd cycle KCD 2849 ?
Feb 7, 2015 2589 67.3
Re: Significance of the C-reactive protein test?
Ian, thank you so much for your reply. As for the answer as to what the CRP level was prior to December 10th, I do not know. His first oncologist never ran that test, EVER. So, needless to say, I am quite concerned in regards to that.
The positives I am trying to hold onto is, that back in October his light chains were 7700 and, as of February 7th, they are down to 2589. His creatinine levels remain good. He has no bone involvement and even his anemia is starting to moderate somewhat.
I thought I would add all of his light chain readings from the beginning.
2014 (RVD started in August)
Date L FLC
Jul 11 3692
Aug 04 7700
Aug 25 3750
Sep 15 4590
Sep 19 4440
Sep 24 2720
Oct 06 5330
Oct 15 3550
Nov 03 4370
Nov 12 3490
Nov 20 1670
Dec 01 2320
December 10th is when we transferred to the specialist, who originally was going to start him at the Kyprolis on the standard dosage, then for his second cycle bump him up to the 45 dosage. However, since he had such a good response to his first cycle with the Kyprolis at the standard dose, he decided to keep him on that since the risks of the increase in dosage did not outweigh the good response he got from the standard dosing.
Dec 10 L FLC = 5594, CRP = 39.7 B2M = 6.34
2015 (on Kyprolis, Cytoxan, and dex)
Jan 07 L FLC = 2722
Jan 31 L FLC = 2849
Feb 07 L FLC = 2589, CRP = 67.3, B2M = 4.53
All of this does make me wonder if the elevated CRP has anything to do with the erratic results of his light chains.
The positives I am trying to hold onto is, that back in October his light chains were 7700 and, as of February 7th, they are down to 2589. His creatinine levels remain good. He has no bone involvement and even his anemia is starting to moderate somewhat.
I thought I would add all of his light chain readings from the beginning.
2014 (RVD started in August)
Date L FLC
Jul 11 3692
Aug 04 7700
Aug 25 3750
Sep 15 4590
Sep 19 4440
Sep 24 2720
Oct 06 5330
Oct 15 3550
Nov 03 4370
Nov 12 3490
Nov 20 1670
Dec 01 2320
December 10th is when we transferred to the specialist, who originally was going to start him at the Kyprolis on the standard dosage, then for his second cycle bump him up to the 45 dosage. However, since he had such a good response to his first cycle with the Kyprolis at the standard dose, he decided to keep him on that since the risks of the increase in dosage did not outweigh the good response he got from the standard dosing.
Dec 10 L FLC = 5594, CRP = 39.7 B2M = 6.34
2015 (on Kyprolis, Cytoxan, and dex)
Jan 07 L FLC = 2722
Jan 31 L FLC = 2849
Feb 07 L FLC = 2589, CRP = 67.3, B2M = 4.53
All of this does make me wonder if the elevated CRP has anything to do with the erratic results of his light chains.
-
Melanie - Name: Melanie
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: July 2014
- Age at diagnosis: 54
Re: Significance of the C-reactive protein test?
Hi Melanie,
My understanding of C reactive protein is that it is a very general marker. It tells you that you have inflammation in the body somewhere, but it doesn't specifically pinpoint the area of the inflammation. I did a quick Google search on c reactive protein and myeloma and found a number of articles discussing the level of c reactive protein as a prognostic indicator, but these articles were quite old.
Lyn
My understanding of C reactive protein is that it is a very general marker. It tells you that you have inflammation in the body somewhere, but it doesn't specifically pinpoint the area of the inflammation. I did a quick Google search on c reactive protein and myeloma and found a number of articles discussing the level of c reactive protein as a prognostic indicator, but these articles were quite old.
Lyn
-
Christa's Mom - Name: Christa's Mom
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: September, 2010
- Age at diagnosis: 53
Re: Significance of the C-reactive protein test?
My understanding was it is really only of value when you are looking for diagnosis, since it is a signal of inflammation, but not very specific.
I think the B2M (beta microglobulin) is more specific for myeloma and used for staging more recently.
I think the B2M (beta microglobulin) is more specific for myeloma and used for staging more recently.
-
Anonymous
Re: Significance of the C-reactive protein test?
CRP is a protein that can be elevated in many different states, including inflammation. It is also correlated with IL-6 levels. IL6 is a protein that promotes survival / growth of myeloma cells.
Ultimately, as the disease responds to therapy, CRP levels may fall. However, there is no significant utility to following CRP levels to determine whether myeloma is responding to treatment or progressing, and it is best to follow classic parameters, such as M-protein, free light chain levels, etc.
There is some older data suggesting CRP may be a prognostic tool; however, it is not part of the current staging system.
Ultimately, as the disease responds to therapy, CRP levels may fall. However, there is no significant utility to following CRP levels to determine whether myeloma is responding to treatment or progressing, and it is best to follow classic parameters, such as M-protein, free light chain levels, etc.
There is some older data suggesting CRP may be a prognostic tool; however, it is not part of the current staging system.
-
Dr. Jatin Shah - Name: Jatin Shah, M.D.
Beacon Medical Advisor
Re: Significance of the C-reactive protein test?
Thank you so much for your reply, Dr. Shah.
I realize that the CRP is not used as a staging criteria, but I would suppose they use it as a tool to evaluate the response to treatment.
I also realize that the elevated CRP can indicate inflammation without revealing the source of the inflammation.
So then my next thought would be could that inflammation be caused by the myeloma becoming refractory to the current treatment. My husband's lambda light chains have bounced around so much that we wonder if his myeloma is more aggressive than originally thought.
I realize that the CRP is not used as a staging criteria, but I would suppose they use it as a tool to evaluate the response to treatment.
I also realize that the elevated CRP can indicate inflammation without revealing the source of the inflammation.
So then my next thought would be could that inflammation be caused by the myeloma becoming refractory to the current treatment. My husband's lambda light chains have bounced around so much that we wonder if his myeloma is more aggressive than originally thought.
-
Melanie - Name: Melanie
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: July 2014
- Age at diagnosis: 54
Re: Significance of the C-reactive protein test?
Hi Melanie,
I can completely understand the anxiety you're feeling about your husband's test results. I think we all wish that there was some perfect, infallible way to track the disease.
I think the key thing Dr. Shah wrote in response to your question is this part of his reply:
Maybe it's just me, but it seems that he is rather clearly saying that, even though CRP levels may be related the activity of myeloma cells in the body, lab results such as a patient's M-spike and free light chain levels are really the key things to follow when tracking response to treatment.
I hope that helps a bit, and that your husband continues to respond to his treatment.
I can completely understand the anxiety you're feeling about your husband's test results. I think we all wish that there was some perfect, infallible way to track the disease.
I think the key thing Dr. Shah wrote in response to your question is this part of his reply:
Ultimately, as the disease responds to therapy, CRP levels may fall. However, there is no significant utility to following CRP levels to determine whether myeloma is responding to treatment or progressing, and it is best to follow classic parameters, such as M-protein, free light chain levels, etc."
Maybe it's just me, but it seems that he is rather clearly saying that, even though CRP levels may be related the activity of myeloma cells in the body, lab results such as a patient's M-spike and free light chain levels are really the key things to follow when tracking response to treatment.
I hope that helps a bit, and that your husband continues to respond to his treatment.
8 posts
• Page 1 of 1