Hi,
I had an autologous stem cell transplant previous year, and since then my doctor follows the disease with multi parameter flow cytometries. Prior to the transplant, I had a residual disease of 0.15% and now the residual disease is 0.58%. Could this mean that I am relapsing or that i have relapsed already? All the other tests are fine.
Best regards
Jo
Forums
8 posts
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Re: Rise in MRD by multiparameter flow cytometry - concern?
Without knowing your history and the specifics of your multiple myeloma it would be difficult to say anything concrete. This is especially true given the unknown method that your practice uses for MFC. MFC is an additional -- still not standardized -- flow cytometry based technique to monitor disease that quantifies the level of abnormal plasma cells (myeloma cells) in a bone marrow sample.
I would suggest that these represent small changes that will need to be followed with time and at multiple time points (as do all things with myeloma). This also needs to be taken into the context of other myeloma parameters (SPEP, UPEP, qIg, SFLC, and others ... ). Further, residual is present in essentially everyone with multiple myeloma. To have very small amounts is the goal to protect you from the toxicities of myeloma.
Easy to say and not easy to do :v Please be patient and be pleased at where you are in terms of excellent disease control. Keep us posted if/when you learn more from your oncologist.
I would suggest that these represent small changes that will need to be followed with time and at multiple time points (as do all things with myeloma). This also needs to be taken into the context of other myeloma parameters (SPEP, UPEP, qIg, SFLC, and others ... ). Further, residual is present in essentially everyone with multiple myeloma. To have very small amounts is the goal to protect you from the toxicities of myeloma.
Easy to say and not easy to do :v Please be patient and be pleased at where you are in terms of excellent disease control. Keep us posted if/when you learn more from your oncologist.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Rise in MRD by multiparameter flow cytometry - concern?
Hi Dr. Ken Shain,
Thank you very much for your response. My SPEP and UPEP is negative, serum free light chains are in normal range with normal ratio. The reason of the test was a positive serum immunofixation with oligoclonal background.
The cytology was normal with less than 5% of plasma cells. The only point of concern was the increase of the myeloma plasma cells from 0.15% to 0.58%. It was planned to proceed to a 2nd asct only in case that i am in CR, so i am not sure whatis going to happen now....
Best regards
Jo
Thank you very much for your response. My SPEP and UPEP is negative, serum free light chains are in normal range with normal ratio. The reason of the test was a positive serum immunofixation with oligoclonal background.
The cytology was normal with less than 5% of plasma cells. The only point of concern was the increase of the myeloma plasma cells from 0.15% to 0.58%. It was planned to proceed to a 2nd asct only in case that i am in CR, so i am not sure whatis going to happen now....
Best regards
Jo
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Anonymous
Re: Rise in MRD by multiparameter flow cytometry - concern?
Hi Jo,
I would highlight one other point to Dr. Shain's comments that he allutes to indirectly. Myeloma is a patchy disease and MRD (by whatever method) only evaluates the sample collected. The changes you describe are really, really small which can probably be explained by sampling error. This is a deficiency of putting too much emphasis on BMA results.
There are tests (either imaging or blood test) that effectively sample the entire body. These tests have the disadvantage of often being less sensitive for this very reason. Your results look very good and like Dr. Shain says you should monitor the trends but don't get too worked up on minor fluctuations that are simply part of testing process.
Congratulations for your good success and all my best to you in the future.
Dan
I would highlight one other point to Dr. Shain's comments that he allutes to indirectly. Myeloma is a patchy disease and MRD (by whatever method) only evaluates the sample collected. The changes you describe are really, really small which can probably be explained by sampling error. This is a deficiency of putting too much emphasis on BMA results.
There are tests (either imaging or blood test) that effectively sample the entire body. These tests have the disadvantage of often being less sensitive for this very reason. Your results look very good and like Dr. Shain says you should monitor the trends but don't get too worked up on minor fluctuations that are simply part of testing process.
Congratulations for your good success and all my best to you in the future.
Dan
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Dan in Phoenix
Re: Rise in MRD by multiparameter flow cytometry - concern?
Thank you all,
I was just anxious about that. I know that there will always be some residual myeloma cells in the bone marrow.
My doctor said that maybe the disease is proliferating and that a second transplant could help me erradicate this residual cells. What do you think about this? Do you follow your disease with flow cytometries and did you ever have fluctuations like that?
Best regards
Jo
I was just anxious about that. I know that there will always be some residual myeloma cells in the bone marrow.
My doctor said that maybe the disease is proliferating and that a second transplant could help me erradicate this residual cells. What do you think about this? Do you follow your disease with flow cytometries and did you ever have fluctuations like that?
Best regards
Jo
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Anonymous
Re: Rise in MRD by multiparameter flow cytometry - concern?
While another transplant is of course an option, have you asked your doctor what other options there are (including not yet treating), and why he/she ranks the options in the way he/she does?
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dnalex - Name: Alex N.
- Who do you know with myeloma?: mother
- When were you/they diagnosed?: 2007
- Age at diagnosis: 56
Re: Rise in MRD by multiparameter flow cytometry - concern?
Hi Dnalex,
My doctor believes that the residual disease is not much, and that if we try to erradicate it, there is a big chance of a long term remission. He belives that there are 2 options for the eradication:
1) Consolidation with novel agents now and then stem cell transplant and maintenance
2)Stem cell transplant now, consolidation after and then maintenance.
He is 100% sure that we can achieve the MRD negative target and 50% that this will results in a long term remission.
Best regards
Jo
My doctor believes that the residual disease is not much, and that if we try to erradicate it, there is a big chance of a long term remission. He belives that there are 2 options for the eradication:
1) Consolidation with novel agents now and then stem cell transplant and maintenance
2)Stem cell transplant now, consolidation after and then maintenance.
He is 100% sure that we can achieve the MRD negative target and 50% that this will results in a long term remission.
Best regards
Jo
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Anonymous
Re: Rise in MRD by multiparameter flow cytometry - concern?
Dear all,
I received all the tests from my oncologist, and I found out that, except for the small rise in MRD, there is also a positive urine immunofixation with my monoclonal protein.
I talked with him about that, and he told me that this means that there is just a low level of minimal residual disease, and that's why we cannot detect it with the 4 colour flow cytometry but only with the 8 colours.
As far as the urine immunofixation, he wasn't concerned about it. He believes that if I will proceed fast to another transplant, I will probably be disease free for a long time. Lets hope that he is right.
Best regards,
Jo
I received all the tests from my oncologist, and I found out that, except for the small rise in MRD, there is also a positive urine immunofixation with my monoclonal protein.
I talked with him about that, and he told me that this means that there is just a low level of minimal residual disease, and that's why we cannot detect it with the 4 colour flow cytometry but only with the 8 colours.
As far as the urine immunofixation, he wasn't concerned about it. He believes that if I will proceed fast to another transplant, I will probably be disease free for a long time. Lets hope that he is right.
Best regards,
Jo
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Anonymous
8 posts
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