[Karen]

Will relapse show up in blood work before bones?

by Karen on Wed Jun 06, 2012 5:16 pm

Hi,

I'm currently in remission after having been treated with Velcade, Revlimid and dexamethasone as part of a Phase III clinical trial. I finished the first 8 cycles of the trial in July 2011, and since then have been on a maintenance dose of Revlimid. All of my blood work has been completely normal and my last bone marrow biopsy showed no evidence of disease. (I didn't have a SCT).

When I was diagnosed, my bone marrow biopsy was at about 10%, and there were lesions in several bones. However, the disease had not affected any organs. Since diagnosis, I've been seeing the orthopedic oncologist about every 3-4 months and she says she sees no signs of further lesions - she believes the lesions I had are slowly getting smaller (I know there is some debate about whether that's actually possible.)

My question now is that, since my bones were the only areas affected by the multiple myeloma before I started treatment, I'm most worried that, if the disease recurs, I'll get more lesions, or the lesions I have will get worse.

Is it possible to answer the question of whether a recurrence of multiple myeloma will show up in blood work before it has a chance to start affecting the bones? Or is it not that black and white? I would love to stop worrying about every little ache and pain!

(I should probably add that as I'm still in the clinical trial, I have very thorough blood work done every month, including 24-hour-urine tests.)

[Dr. Edward Libby]

Re: Will relapse show up in blood work before bones?

by Dr. Edward Libby on Thu Jun 07, 2012 4:42 pm

Hello from Seattle!

Weather report here: Gray, cool and rainy. Juneuary they call it.

Excellent question.

For the vast majority of patients, it is possible to follow the myeloma response and occurrence of relapse using serum protein electrophoresis (SPEP), serum free light chains (FLC) and / or 24-hour urine for electropohresis (UPEP). This means that your oncologist can see from your blood tests if the myeloma is in remission or if you are relapsing. A relapse can generally be diagnosed in advance of major changes in lytic lesions, kidny function,anemia etc.

There are rare patients (fewer and fewer because of the FLC assay) whose myeloma does not secrete any protein whatsoever. These patients are described as "nonsecretory myeloma". The only way they can be accurately followed is with repeat bone marrow biopsies.

[Karen]

Re: Will relapse show up in blood work before bones?

by Karen on Fri Jun 08, 2012 6:44 am

Thanks very much, Dr. Libby - that is reassuring. I was grumbling about having to do all of this blood work and the urine test every month (and I'm also having a CBC done in the middle of each month), but I think it's better to deal with that and catch any recurrence early, rather than have it progress and start affecting my bones again. I broke my scapula in a fall (which is what led to my diagnosis) and definitely don't want to break anything else!

Karen