[Dakotauk]

Do these numbers suggest relapse?

by Dakotauk on Sat Dec 17, 2016 11:20 am

Hi

I'm new to this site but hope you can provide some advice.

My wife was diagnosed earlier this year with lambda FLC disease. Her lambda FLC were 6990. She was diagnosed with stage III disease, aki and collapsed L3/L4 for which she had vertebroplasty. 80% plasma cells. She had 4 cycles of cyclophosphamide (Cytoxan), thalidomide, and dexamethasone (CTD), which provided a very good partial response (VGPR). She had auto stem cell transplant 6 months ago and obtained a stringent complete response. Bone marrow biospy showed no evidence of disease.

3 weeks ago we were told that she had developed a M-spike of 0.6 (IgG lambda type) with increased kappa 31.1 and lambda 57.3 with a normal ratio. The IgG is new and so is the kappa FLC. Is this relapse? Could it be oligoclonal banding etc.? Any help would be appreciated.

One other point, she was re-immunised before the above bloods and has complained of bilateral shoulder pain (although the doctors dismissed these).

Many thanks.

Dakota

[Multibilly]

Re: Do these numbers suggest relapse?

by Multibilly on Sat Dec 17, 2016 9:05 pm

Hi Dakotauk,

You might want to read through this article.

http://www.bloodjournal.org/content/91/9/3518?sso-checked=true

Since your wife presented with light chain myeloma and then developed a heavy chain (Ig) spike after the transplant, technically I believe this would be referred to as an isotype switch (IS) instead of as oligoclonal banding (OB).

"An apparent isotype switch (IS) was defined as a single distinct protein band with a different heavy chain class or light-chain type from the original paraprotein. This included the appearance of an intact serum Ig band in patients presenting with light-chain disease only."

In any case, it seems like this could be temporary situation - but clearly your doctor would need to make that call. I think you would need to actually look at the before-and-after electrophoretic printouts to truly sort out if this is only an isotype switch or an isotype switch accompanied by oligoclonal banding.

[Dakotauk]

Re: Do these numbers suggest relapse?

by Dakotauk on Sun Dec 18, 2016 4:34 pm

Hi Multibilly

Thank you for taking the time to post a reply. The article is very interesting. Myeloma is such a complex disease and very individual. Thank you once again.

Dakotauk

[Dakotauk]

Re: Do these numbers suggest relapse?

by Dakotauk on Mon Dec 19, 2016 9:19 am

Hi,

Further update on the above. After repeat bloods, my wife's IFE has changed from IgG lambda (bloods 3 weeks ago) to now showing same M-spike but comments now changed to "showing 2 bands within the IgG region, one in the IgM region and one in the IgA region".

Kappa FLC remain elevated, so do lambda (no changes to original post) ratio normal. Albumin normal. Creatinine slightly elevated at 100. Hb/platelets/white cell counts have all improved from 3 weeks ago.

Any clues? Has anyone else experienced this?

Dakotauk