I'm trying to understand the latest lab results for my husband, diagnosed with IgA multiple myeloma, Stage 2, last December, and in his sixth cycle of chemotherapy with dex, Revlimid, Velcade, and Zometa.
Original testing on January 26, 2015 was:
CD138 positive (10%) Kappa (co express CD79a)
FISH results normal
SPEP showed IgA kappa accounting for 0.46 g/dL of total 1.08 g/dL of protein in gamma region, with decreased IgG and IgM. IgM was 55 mg/dL, IgG was 547 mg/dL and IgA was 516 mg/dl.
Kappa free light chains were 58.80 mg/dl and lambda free light chains were 107 mg / dl - showing K:L ratio of 54.95.
Beta 2 was 3.5.
His newest lab results this past month read as follows:
SPEP with IFE slight restriction of protein migration faint band IgG lambda consistent with immune response of early monoclonal protein. IgA levels has fallen to 111 and kappa free light chain level to 2.58.
Normal cytogentics.
Also, in June they list ANEUTS with a value of 8.47.
So then ... What exactly does this all mean in terms of remission? I know the numbers for IgA have fallen from 516 to 111 and the kappa free light chains from 58.80 to 2.58. But does this mean he's achieved remission, or is close to it?
My understanding is that you may never get "normal" since it's a chronic disease, but when do they consider you in remission.
Should I be looking at the Beta 2 numbers too?
What exactly will his "normal cytogenetics" mean in terms of remission / relapse?
I have no idea what the ANEUTS is ... first time I've seen that.
Also, wondering if he will see more normal CBC numbers once he's on the Revlimid maintenance?
Thanks for helping me interpret! Especially the SPEP.
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LauraB - Name: LauraB
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: Dec 2014
- Age at diagnosis: 72
Re: Is my husband now in remission?
Hi Laura,
Looks like your husband has responded well to his treatment. Based on the information you've provided, he's achieved at least a very good partial response to treatment. You would need some additional information, and probably some interpretation of the immunofixation results by your husband's doctor, to figure out if he's achieved a complete response, or perhaps even a stringent complete response.
The different types of response to treatment -- complete response, very good partial response, partial response, etc. -- are defined in Table 1 of this journal article:
SV Rajkumar et al, "Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1," Blood, May 5, 2011 (full text of article; pdf also available)
In looking at the definitions, remember that the "protein electrophoresis" referred to in the definitions are tests that go by acronyms such as SPEP (for the blood test) and UPEP (for the urine test). Those tests tell you how much of an M-spike, if any, is in the blood and urine.
The immunofixation test (IFE, either blood or urine) is a more sensitive test that simply tells you whether or not a monoclonal protein is present, and what its heavy and light chain type is (IgG lambda, IgA kappa, etc.)
I think most of the rest of the definitions in the table are probably self-explanatory.
Was the January test the first set of lab results your husband had? I ask because it seems to me that those tests would have been done after he started treatment, not before. To determine a patient's response to treatment, you want the lab results from before the start of treatment as the basis.
As I said, one thing that is not completely clear to me in your husband's recent results is the statement that his immunofixation (IFE) shows a "slight restriction of protein migration faint band IgG lambda consistent with immune response of early monoclonal protein". I would say this indicates that he still has some monoclonal protein detectable, but I'm not a doctor, so I can't say for sure.
I suspect ANEUTS is the absolute neutrophil count, which is often abbreviated "ANC". Do you have previous ANC results in his tests? Has the count been moving around?
I know I haven't answered your question completely, but I thought this would start the ball rolling. If you have more questions, just ask.
Looks like your husband has responded well to his treatment. Based on the information you've provided, he's achieved at least a very good partial response to treatment. You would need some additional information, and probably some interpretation of the immunofixation results by your husband's doctor, to figure out if he's achieved a complete response, or perhaps even a stringent complete response.
The different types of response to treatment -- complete response, very good partial response, partial response, etc. -- are defined in Table 1 of this journal article:
SV Rajkumar et al, "Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1," Blood, May 5, 2011 (full text of article; pdf also available)
In looking at the definitions, remember that the "protein electrophoresis" referred to in the definitions are tests that go by acronyms such as SPEP (for the blood test) and UPEP (for the urine test). Those tests tell you how much of an M-spike, if any, is in the blood and urine.
The immunofixation test (IFE, either blood or urine) is a more sensitive test that simply tells you whether or not a monoclonal protein is present, and what its heavy and light chain type is (IgG lambda, IgA kappa, etc.)
I think most of the rest of the definitions in the table are probably self-explanatory.
Was the January test the first set of lab results your husband had? I ask because it seems to me that those tests would have been done after he started treatment, not before. To determine a patient's response to treatment, you want the lab results from before the start of treatment as the basis.
As I said, one thing that is not completely clear to me in your husband's recent results is the statement that his immunofixation (IFE) shows a "slight restriction of protein migration faint band IgG lambda consistent with immune response of early monoclonal protein". I would say this indicates that he still has some monoclonal protein detectable, but I'm not a doctor, so I can't say for sure.
I suspect ANEUTS is the absolute neutrophil count, which is often abbreviated "ANC". Do you have previous ANC results in his tests? Has the count been moving around?
I know I haven't answered your question completely, but I thought this would start the ball rolling. If you have more questions, just ask.
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JimNY
Re: Is my husband now in remission?
Hi Laura,
I have no answer to your question and only know from my experience with my dad. He had smoldering myeloma for 7 years before starting treatment. He lived 8 more years after that.
During the 8 years there were very nice long breaks where he would be able to go off the chemo and he did very well. Then his numbers would spike again, and he would be back on treatment, although I will say that he was able to maintain most of the things he loved doing right up until the last year.
I wish you and your family all the best and am hoping this is only the beginning of a very long time with good counts.
I have no answer to your question and only know from my experience with my dad. He had smoldering myeloma for 7 years before starting treatment. He lived 8 more years after that.
During the 8 years there were very nice long breaks where he would be able to go off the chemo and he did very well. Then his numbers would spike again, and he would be back on treatment, although I will say that he was able to maintain most of the things he loved doing right up until the last year.
I wish you and your family all the best and am hoping this is only the beginning of a very long time with good counts.
Re: Is my husband now in remission?
Sorry it took so long to post a reply. Been a little busy getting our youngest off to college and trying to manage all the health insurance issues.
In any event, yes, my husband's results were from the month after he started treatment and again when I posted.
This month we saw Dr. Laubach at Dana Farber in Boston, and we decided to forego the stem cell transplant because he has responded so well. He will be on maintenance with Revlimid after an additional two months of chemo treatment (which the doc opted to do in lieu of the stem cell transplant). So far so good.
Thanks for posting a reply to help me understand results better.
In any event, yes, my husband's results were from the month after he started treatment and again when I posted.
This month we saw Dr. Laubach at Dana Farber in Boston, and we decided to forego the stem cell transplant because he has responded so well. He will be on maintenance with Revlimid after an additional two months of chemo treatment (which the doc opted to do in lieu of the stem cell transplant). So far so good.
Thanks for posting a reply to help me understand results better.
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LauraB - Name: LauraB
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: Dec 2014
- Age at diagnosis: 72
4 posts
• Page 1 of 1