[floridagirl]

Relapse 10 months after SCT - what's it mean?

by floridagirl on Tue Mar 03, 2015 7:10 pm

Hi All,

I've been searching the forum but not finding anything specific on this topic.

My 68-year-old father was diagnosed with multiple myeloma approximately November 2013. He had a stem cell transplant (SCT) in May / June 2014. He had multiple myeloma disease evidence in literally every bone in his body, including the jaw, when he was first diagnosed. He had a very good partial remission after the transplant. Now his protein levels are showing an increase.

Are there any statistics or similar stories of what a relapse after 10 months has in store for us? I know it cannot be good, and he is not in official relapse yet, as the protein levels are just starting to increase from the zero that they've been at since transplant.

Does the fact that his myeloma was so widespread play a part in the prognosis, even though he had remission after the transplant, or is it normal to be in remission after the transplant?

Any info appreciated, our family is devastated.

Thanks!!!

[Ron Harvot]

Re: Relapse 10 months after SCT - what's it mean?

by Ron Harvot on Wed Mar 04, 2015 12:59 am

Sorry to hear about your father.

I don't know about statistics, but the follow-up will likely be the same whether a person relapses 10 months or 5 years after the SCT. Generally, induction therapy with a triplet VRD (Velcade, Revlimid, dexamethasone) or KRD (Kyprolis, Revlimid, dex) is given to knock the multiple myeloma back down, followed by maintenance, usually Revlimid and dex.

There are a lot of options with novel agents.

Hope they find a treatment that works for him.

Ron

[Dr. Heather Landau]

Re: Relapse 10 months after SCT - what's it mean?

by Dr. Heather Landau on Wed Mar 04, 2015 1:31 am

Hi floridagirl,

While aggressive disease progression (i.e., new bony disease and quickly rising M-protein shortly after transplant) are associated with poor outcomes, low-level relapse, with a return to an "MGUS"-like state, or the emergence of an M-protein different than the original, are NOT necessarily unfavorable.

In fact, patients who develop what we call "oligoclonal reconstitution," which is the term we use for new M-spikes that can develop after transplant – usually at low levels – is actually associated with a favorable outcome.

So:

1. His disease relapse should be confirmed
2. Make certain that the protein that is detected indeed is the same as what was detected before the transplant; and
3. Understand that a low-level relapse can persist for some time (years) before requiring intervention, as if the disease returned to a "MGUS" state.

Lastly, just by virtue of his having widespread bony disease dose NOT indicate that his prognosis is poor.

Hope this helps!!!
Best.

[tpt]

Re: Relapse 10 months after SCT - what's it mean?

by tpt on Wed Mar 04, 2015 8:58 pm

Hi all,

My Dad had ASCT in September 2013, but he never really achieved CR. Post-transplant, his kappa FLC always hovers around the 20s (around 50s pre-transplant). Last week's test indicates a slight increase to 29, and a ratio of 1.85. His disease does not secrete M-spike. Doctor suggests maintenance, but we still want to see if it is possible to wait and see. (Is it possible?) He is p53, by the way.

So, following up your comment, Dr. Heather, how do you know if the M-spike is different from the original M spike if the patient does not secrete M spike to begin with? That is, how do we know if this is coming back to the MGUS state or a relapse?

Thanks.