My father has had blood work done and a bone marrow biopsy. The former reports that his "light-chain" number has decreased significantly...definitely a good sign (his numbers went from somewhere in the 600s all the way down to 20).
However, the biopsy revealed that the percentage of cancer cells in his plasma had increased.
How can these 2 things happen simultaneously? Doesn't lowering the light-chain number lower the percentage of cancer cells in the plasma? Instead, it seems one number has gone down while the other has gone up.
What does this mean?
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bitca88 - Name: bitca88
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: December 2011
- Age at diagnosis: 61
Re: Question about Cancer Cells
Question for you bitca: Did your father receive any treatment that caused his light chains to drop, or did they do that on their own?
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Cindylou
Re: Question about Cancer Cells
Dear bitca88,
Your father is a victim of the limitations of the tests we use to monitor myeloma. Myeloma is a patchy disease. The levels of myeloma cells on a biopsy can vary significantly from one area to the next. As such, the second biopsy may have been obtained in an area that was more heavily involved with disease from the beginning. In addition, you have to be careful with the way myeloma burden is reported on a marrow. There is the percentage of myeloma cells in the blood sample from the marrow (the % of myeloma cells in the bone marrow aspirate) and the CD138 stain of the bone marrow biopsy. The CD138 test tends to yield a higher number than the aspirate. Flow cytometry estimates the myeloma burden at an even lower percentage than the aspirate count. As such, it might be worth seeing if you are comparing apples to apples or apples to oranges.
On the other side of the spectrum, the serum free light chain assay is also fallible (I am assuming the light chains you refer to are derived from the the serum free light chain test, but you may be referring to urine light chains). We have seen instances where when the serum free light chain level gets so high that the machine that runs the test is thrown off and reads the result out as artificially low.
I would repeat the serum free light chain test and get a 24 hour urine collection and reassess the situation. I suspect the second marrow results are misleading. Are there other signs that things are better clinically? Less fatigue? Less pain? Better kidney function (if it was abnormal at the beginning)?
Take care and good luck!
Pete V.
Your father is a victim of the limitations of the tests we use to monitor myeloma. Myeloma is a patchy disease. The levels of myeloma cells on a biopsy can vary significantly from one area to the next. As such, the second biopsy may have been obtained in an area that was more heavily involved with disease from the beginning. In addition, you have to be careful with the way myeloma burden is reported on a marrow. There is the percentage of myeloma cells in the blood sample from the marrow (the % of myeloma cells in the bone marrow aspirate) and the CD138 stain of the bone marrow biopsy. The CD138 test tends to yield a higher number than the aspirate. Flow cytometry estimates the myeloma burden at an even lower percentage than the aspirate count. As such, it might be worth seeing if you are comparing apples to apples or apples to oranges.
On the other side of the spectrum, the serum free light chain assay is also fallible (I am assuming the light chains you refer to are derived from the the serum free light chain test, but you may be referring to urine light chains). We have seen instances where when the serum free light chain level gets so high that the machine that runs the test is thrown off and reads the result out as artificially low.
I would repeat the serum free light chain test and get a 24 hour urine collection and reassess the situation. I suspect the second marrow results are misleading. Are there other signs that things are better clinically? Less fatigue? Less pain? Better kidney function (if it was abnormal at the beginning)?
Take care and good luck!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Question about Cancer Cells
This is a more detailed and accurate follow up post to one my son (bitca88) posted on my behalf about three weeks ago. I am sincerely hoping that someone can weigh in with some sage advice, to wit:
I was diagnosed last December 2011 with stage 3 multiple myeloma. After some radiation I started on Rev/Dex around the end of January with a Kappa light chain number of around 6400 that came down to around 650 with the Rev/Dex. (Lambda has always been within parameter.) After my 3rd round of Rev/Dex I regressed to around 1040, but after going on Rev/Velcade/Dex weeks later my numbers came down after two cycles to 21. Life is good right?
At the same time as my light chains had come down to 21, my second FISH showed that I now had a del (13) chromosome and that my cancerous blood marrow cells had jumped from 30% of the total to 60% plus! (This is after my first FISH done in April had showed no del (13) and total cancerous cells at around 30%.) The question is how and why would my second FISH, after going on the Rev/Vel/Dex show the opposite reaction –greatly increased cancerous cells in my marrow, PLUS del (13) – when the same regimen dropped my light chains, which I had come to believe was the gold standard to measure for readiness for stem cell transplant, so precipitously??
I am now undergoing at least 2 three week cycles of “high dose” chemotherapy with Cyclophosphamide and Mesna along with Etoposide and Cisplatin.
Any insights would be greatly appreciated. I am hoping that the second FISH was an aberration of some sort, and that the high dose chemo will show that.
Last, but not least, and I don’t want to burden you all, but if you could comment/update two postings on the Beacon over the last several years that would seem to have significance on my situation, and numerous others I would bet:
That “there is no problem with performing additional FISH cytogenetics, but it should not replace metaphase [conventional] cytogenetics because it [FISH]has an inferior prognostic significance.”
AND the second posting having to do with normal vs abnormal metaphase cytogenetics (AMC) having to do with del (13) chromosome:
That is that approx HALF of of the folks that have the del (13) are AMC, which is what you must have –abnormal – for the del(13) to have any real [bad] signifcance for you. The other approx 50% who have normal metaphase cytogenetics (NMT) are no different, prognostically speaking, than if you had no del (13) chromosome at all! (I believe this study was done about 6 years ago by researchers at the University of Arkansas.) Is this study still accurate?
I know this is a lot to ask in one post, but I do believe that the answers will help many others than just myself.
I was diagnosed last December 2011 with stage 3 multiple myeloma. After some radiation I started on Rev/Dex around the end of January with a Kappa light chain number of around 6400 that came down to around 650 with the Rev/Dex. (Lambda has always been within parameter.) After my 3rd round of Rev/Dex I regressed to around 1040, but after going on Rev/Velcade/Dex weeks later my numbers came down after two cycles to 21. Life is good right?
At the same time as my light chains had come down to 21, my second FISH showed that I now had a del (13) chromosome and that my cancerous blood marrow cells had jumped from 30% of the total to 60% plus! (This is after my first FISH done in April had showed no del (13) and total cancerous cells at around 30%.) The question is how and why would my second FISH, after going on the Rev/Vel/Dex show the opposite reaction –greatly increased cancerous cells in my marrow, PLUS del (13) – when the same regimen dropped my light chains, which I had come to believe was the gold standard to measure for readiness for stem cell transplant, so precipitously??
I am now undergoing at least 2 three week cycles of “high dose” chemotherapy with Cyclophosphamide and Mesna along with Etoposide and Cisplatin.
Any insights would be greatly appreciated. I am hoping that the second FISH was an aberration of some sort, and that the high dose chemo will show that.
Last, but not least, and I don’t want to burden you all, but if you could comment/update two postings on the Beacon over the last several years that would seem to have significance on my situation, and numerous others I would bet:
That “there is no problem with performing additional FISH cytogenetics, but it should not replace metaphase [conventional] cytogenetics because it [FISH]has an inferior prognostic significance.”
AND the second posting having to do with normal vs abnormal metaphase cytogenetics (AMC) having to do with del (13) chromosome:
That is that approx HALF of of the folks that have the del (13) are AMC, which is what you must have –abnormal – for the del(13) to have any real [bad] signifcance for you. The other approx 50% who have normal metaphase cytogenetics (NMT) are no different, prognostically speaking, than if you had no del (13) chromosome at all! (I believe this study was done about 6 years ago by researchers at the University of Arkansas.) Is this study still accurate?
I know this is a lot to ask in one post, but I do believe that the answers will help many others than just myself.
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