[hydengr]

Revlimid to treat MGUS?

by hydengr on Mon Jan 12, 2015 12:06 pm

Morning,

I saw the hem-onc last Friday. My free light chain ratio has moved out of the normal range and measured 2.03. My M-spike has remained fairly constant at 1.2 g/dl (12 g/l) for about a year when I was first diagnosed with MGUS. IgG was 1776 mg/dL, which is flagged as high, but I'm not sure how this is trending; I'll have to look at my last blood work results.

There's some additional info about my case in my first post back in June, 2014:

"Yet another member of this oh-so-complicated community"

The hem-onc said that if my free light chain ratio continued to increase, she'd put me on a low dose of Revlimid. Anybody out there undergoing "similar treatment"?

Thanks in advance.
Mark

[Multibilly]

Re: Revlimid to treat MGUS?

by Multibilly on Mon Jan 12, 2015 12:23 pm

Mark,

An FLC ratio of 2.03 is really not that significant. You might want to review the new criteria for symptomatic multiple myeloma. One starts to get concerned as the FLC ratio gets in the range of 100.

SV Rajkumar, "New Criteria For The Diagnosis Of Multiple Myeloma And Related Disorders," The Myeloma Beacon, Oct 26, 2014.

Based only on what you've said here, I am surprised that your doc would recommend treatment if the FLC ratio "continued to increase". The ratio would have to increase quite a bit to become worrisome. From just these numbers, it doesn't even sound like you are at the smoldering stage, and your numbers are far better than mine (I am smoldering).

Are you working with a doctor who specializes in multiple myeloma or just a general hem-onc?

[hydengr]

Re: Revlimid to treat MGUS?

by hydengr on Mon Jan 12, 2015 12:55 pm

Morning Multibilly,

Thanks for your reply. Not sure if my hem-onc is a specialist in multiple myeloma. I did see another onc-hem last July who was a specialist in multiple myeloma. Ironically, he originally questioned why I wasn't already being treated, since some of my test results appear to show active CRAB symptoms (history of high calcium, bone issues, mildly anemic). He re-ran some bloodwork and did a fat pad biopsy and agreed with my current hem-onc's 'wait and see, continue to monitor' approach.

I'll take a look at the link that you provided. Thanks.

Mark

[Multibilly]

Re: Revlimid to treat MGUS?

by Multibilly on Mon Jan 12, 2015 1:13 pm

Mark,

Well, if any CRAB symptoms are also in play here, then that potentially puts a different spin on things. When evaluating the need for treatment, one needs to look at the overall picture, not just the FLC ratio, M-spike and IgG levels.

[hydengr]

Re: Revlimid to treat MGUS?

by hydengr on Mon Jan 12, 2015 1:30 pm

Multibilly,

Understand that "CRAB" symptoms factor heavily into diagnosis and treatment options. Recently read where the Mayo Clinic identified the 3 factors that I mentioned (FLC ratio, M-spike and IgG levels) as influencing progression from MGUS to multiple myeloma. That's the only reason that I honed in on those factors.

So ... Anybody out there currently diagnosed with MGUS but taking low doses of Revlimid? Just curious ...

Thanks!
Mark