[laetetia]

Relapse

by laetetia on Mon May 23, 2011 2:18 am

Just wondering what paraprotein level is considered as a relapse? My husband has been drug free since 2001 after undergoing a stem cell transplant with his own stem cells. His paraprotein level climbed very slowly over several years although the last few years have seen it jump by 1 or 2 every few months (but occassionally it goes down 1 as well). He is now at a level of 14.2 (was around 13, then went to 12 and now up to 14 over the last three tests since late last year). His doctor wants him to start on thalidomide and blood thinners. He was told he wasn't allowed to start anything else because the spike wasn't large enough to get government approval.

What he is scared of is that if we wait, then he might need more drastic treatment to reduce the level like chemo or another stem cell treatment . The doctor said his light chains were increasing lately also.

If he was to take thalidomide and it did bring his levels down, can he stop and then should it go up again later, do another round? Or once you start on medication is it just a cycle of keep going or taking one medication after another ?

He is also very frightened of the PN. He still works and is also a part time musician.

[Dr. David Vesole]

Re: Relapse

by Dr. David Vesole on Wed May 25, 2011 3:18 pm

I am not sure I understand the units that you express your husband's protein levels.

Progressive disease is defined as a 25% increase in paraprotein parameters and a minimum of 0.5 g. For example, if he had an M protein of 1 gram, he would need to reach a level of 1.5 g to be considered progression. If he had an M protein of 2 grams, he would need a level of 2.5 grams (25% and 0.5 increase).

"Early biochemical relapse" is a term we use for patients who have an increase in their myeloma paraprotein but do not have any symptoms or organ compromise. These patients can be observed closely without treatment. There is no immediate need to treat unless there is organ compromise or if the myeloma parameters are rapidly increasing.

I think your husband may fall into this definition.

Regarding treatment, major changes have occurred since your husband had his transplant in 2001. We rarely use thalidomide any more due to the toxicities, particularly peripheral neuropathy. There are other drugs that are very active that can be utilized including Revlimid and Velcade.

It may be worthwhile for your husband to see a myeloma specialist if it is feasible.

[laetetia]

Re: Relapse

by laetetia on Wed May 25, 2011 9:54 pm

Thank you. His pararpotein level I'm assuming is the same as the M spike. In Australia, the government won't approve any other line of medication unless you get on thalidomide first and if that fails, then you are allowed to try Revlimid or Velcade. So basically, until you suffer irreversable neuropathy so you have to stop, they aren't allowed to prescribe you something else. Other drugs are allowed as a first up treatment option if the paraprotein level jumps 50% within 6 months. My husband's level has only jumped from 12 to 14 in six months so its only a 17% increase. He is being treated by a haematologist who specialises in cancer but we wanted a second opinion as its sounds like his levels are only increasing very slowly and his organs have been tested and are all fine. His haematologist has been getting him to start on thalidomide since his levels reached 10 which was more than a year ago.