[greenrobin]

Response to treatment - meaning for treatment plan?

by greenrobin on Thu Apr 16, 2015 9:29 pm

Hello,

Greetings and best wishes to you all. I have posted before on the Beacon, about my brother, age 54, diagnosed with IgA kappa multiple myeloma in January of 2015. I read the Beacon every single day.

Tonight, my brother started his 10th of what have been quite difficult rounds of CyBorD [cyclo­phosphamide (Cytoxan), Velcade (bortezomib), and dexamethasone).

His numbers have all been moving in the right direction and he seems to have achieved great results.

The latest protein electrophoresis result was just sent to his inbox tonight. No monoclonal band was detected. Further, a marked reduction in clonal protein in past month. Hypo­gamma­globu­linemia (was mentioned but no explanation for why).

We are all very excited to see this result. We're all left wondering what impact these latest results have on his treatment plan, even this newly started round of CyBorD and/or next steps.

Most of all we are wondering if he has achieved a CR.

Here is some data from the his April 8 labs:

Monoclonal Spike: It says <<DO NOT REPORT>>

but in the comments area it says: Known prior gammopathy, IgG (SHOULD BE IgA) kappa. No monoclonal band detected. Marked reduction in clonal protein in past month.

Hypogammaglobulinemia

IgA Level 70 - 400 mg/dL 187.00
IgG Level 700 - 1600 mg/dL 339.00
IgM Level 40 - 230 mg/dL 6.74

Kappa Free Light Chain 0.330 - 1.940 MG/dL 1.090
Lambda Free Light Chain 0.571 - 2.630 MG/dL 0.270
Kappa/Lambda FLC Ratio 0.260 - 1.650 4.037

Calcium 8.4 - 10.2 mg/dL 8.7
Protein, Total 6.3 - 8.2 g/dL 6.0
Albumin 3.9 - 5.0 g/dL 3.8
BUN 7 - 17 mg/dL 19

IG Light Chains total in serum:
Kappa Light Chain 170 - 370 mg/dL 121.00
Lambda Light Chain 90 - 210 mg/dL 36.80

Would appreciate hearing your thoughts about these results. Do you need any other information from me?

Thanks so very much.

[Multibilly]

Re: Response to treatment - meaning for treatment plan?

by Multibilly on Fri Apr 17, 2015 9:22 am

Hi Greenrobin,

There are different levels of response that one can have to treatment. Dr. Voorhees does a nice job of summarizing them pretty simply in this forum discussion:

"Remission, what does it mean?" (started Jan 3, 2013)

In myeloma, there are many different kinds of remission. For those patients with a measurable "M spike," a partial remission means that the M spike has decreased anywhere from 50% to 90% of the level it was immediately prior to treatment.

A very good partial remission (VGPR) refers to a 90% or greater decrease in the M spike.

A complete remission (CR) means that the M spike is no longer detectable AND there are less than 5% plasma cells on a repeat bone marrow biopsy.

A stringent complete remission (SCR) meets all measures of a standard complete remission, but also includes a normal serum free light chain ratio and the plasma cells on the bone marrow biopsy must be polyclonal."

In a nut, in order to be technically classified as having a CR or a sCR, you would need to have the results of a recent bone marrow biopsy. With only the info you have provided, it sounds like he is at least at a VGPR level.

Hope this helps with understanding the terminology.

[mrozdav]

Re: Response to treatment - meaning for treatment plan?

by mrozdav on Fri Apr 17, 2015 12:01 pm

Is there a difference between VGPR and nCR? Just curious. You would also know that you were not in complete response if your IFE test showed myeloma .. .and that would obviate the bone marrow biopsy, I should think.

[Multibilly]

Re: Response to treatment - meaning for treatment plan?

by Multibilly on Fri Apr 17, 2015 12:56 pm

I "believe" nCR is no longer considered a standard definition for response, as it was part of an older set of response criteria that have since been updated. nCR used to mean:

"A treatment outcome when there are ≤5% plasma cells in the bone marrow but there are detectable myeloma proteins in the serum or urine as measured by standard laboratory techniques".

So, nCR is not quite the same as any of the other newer response designations, including VGPR.

But you should double check with your doc on this.

[greenrobin]

Re: Response to treatment - meaning for treatment plan?

by greenrobin on Fri Apr 17, 2015 1:03 pm

Hi Multibilly,

Your commitment to answer questions, bring information to our attention, and in general discuss various topics on this forum are so appreciated. The link is very helpful, thanks.

I don't see the IFE test mentioned on his list if lab results since the first week of March. Maybe it takes a long time to produce?? It feels as though forever when we are waiting on test results.

Thanks again. Hopefully my brother gets to speak with his specialist before the weekend.

[mrozdav]

Re: Response to treatment - meaning for treatment plan?

by mrozdav on Fri Apr 17, 2015 1:24 pm

Greenrobin,

Your brother's report is a little "head-scratching," but I will venture a response with the under­standing that he will follow up with his treating doctor.

I am also IgA kappa. My doctor has advised that she does not look at the M-spike in my case where the cancer is currently at a low level. This is because for IgA at low level, the M-spike test is not useful. I think that may be why the report states: DO NOT REPORT. She looks more to the quantified IgA, and in your brother's case, that seems to be all right.

In addition, while the IFE is not specifically named, it would seem to be covered in the state­ment that no band was observed, another excellent indication for your brother. The hypo­gamma­globuli­nemia reflects a low white cell count, a largely anticipated result of the drug treatment.

Be sure that your brother discusses all these things with his doctor.

[greenrobin]

Re: Response to treatment - meaning for treatment plan?

by greenrobin on Fri Apr 17, 2015 1:50 pm

Hi Mrozdav,

Thanks for the info - very helpful. We've seen the DO NOT REPORT for the M-spike result on an earlier test and the only explanation offered was that the machine must have broke - still scratching my head about that. I'm sure my brother's specialist, who is extraordinarily busy, will reach out to my brother soon.

Thanks again and best wishes to you.

[greenrobin]

Re: Response to treatment - meaning for treatment plan?

by greenrobin on Sat Apr 18, 2015 8:39 am

This is a link to a very informative post about IgA multiple myeloma and the M-spike:

"IgA and M-spike", Beacon forum discussion started Dec 15, 2014.

[greenrobin]

Re: Response to treatment - meaning for treatment plan?

by greenrobin on Mon Apr 20, 2015 11:17 am

Hi Mrozdav, Multibilly and everyone,

Quick update and a question if you have the time:

We did get an email from my brother's doctor indicating that, yes, his M-spike according to the SPEP test is at zero. IFE was ordered but results are not in yet.

Do you know if induction phase continues on with no change to protocol in the light of favorable IFE test results? Typically, if there is such a thing, does an M-spike of 0, confirmed by IFE, inform a change in treatment approach?

Thank you.

[mrozdav]

Re: Response to treatment - meaning for treatment plan?

by mrozdav on Mon Apr 20, 2015 5:23 pm

Before any changes to the protocol will be effected, your brother's doctor will no doubt analyze all the test results and then probably for two straight months or testing periods. If the results are stable with compete remission having been achieved, then a decision will be made whether to proceed to stem cell transplant or to do maintenance. The maintenance could take various forms, including reduction in dosage of induction drugs.

In my own case, my M-spike has been at zero for quite some time, but I am still waiting for a completely negative IFE result. Let us hope that your brother will have a better result with his IFE.

In one of your postings you indicated that "no band was observed." I interpreted that to mean that his IFE showed no cancer. Did the doctor confirm this and then ask for another IFE to be done? What explanation, if any, did he give your brother about the meaning of the cited phrase?