I'm hoping someone will be able to provide me with some advice regarding my test results.
I was diagnosed with multiple myeloma in August 2010 and underwent treatment with Velcade and Dexamethosone followed by ASCT in January 2011. My kidney function, before treatment, was approximately 13 eGlomular Filtration Rate and, after treatment, it ranges between 30 - 35 eGFR. My Light Chains Assay results have been gradually creeping up. I am on no maintenance therapy. The following is a sample of my LC Assay results:
March 8, 2011 Kappa 39.0 Lambda 16.3 Ratio 2.39
December 2, 2011 Kappa 44.0 Lambda 10.0 Ratio 4.46
October 25, 2012 Kappa 44.4 Lambda 8.3 Ratio 5.35
As you can see, my LC ratios are creeping up. What do you recommend? Should I start maintenance therapy? At what point do the ratios indicate some kind of action?
Any advice that you can give would be greatly appreciated.
Forums
3 posts
• Page 1 of 1
-
coopershawk - Who do you know with myeloma?: No one else.
- When were you/they diagnosed?: August 2010
- Age at diagnosis: 64
Re: Should I start maintenance? Other treatment?
Dear coopers hawk,
At this point, you have been off therapy for almost 2 years. As such, any start of new treatment at this point would probably not be construed as a maintenance therapy but treatment of early biochemical relapse. The studies of Revlimid post-transplant started the maintenance therapy typically 3 months after transplant.
In clinical studies, disease progression as monitored by serum free light chains can be defined as follows:
- 50% increase in the difference between involved and uninvolved FLC levels
from the lowest response level, which must also be an absolute increase of at least
10 mg/dL; OR
- 50% increase in the level of involved FLC AND a 50% increase in the ratio of
involved/uninvolved FLC from the lowest response level.
Your light chains are being measured in mg/L not mg/dL -- correct me if I am wrong.
As such, the increase in the difference of affected and unaffected light chains is just barely >50% (22.7 mg/L to 36.1 mg/L) but the absolute increase has not been enough to declare disease progression (if you were participating in a study). You also do not meet criteria for progression based on the second measure.
Realize that these definitions are imperfect and every case must be evaluated individually. In your case, the disease has only minimally changed over a 1 and a half period of time. As such, you have flexibility as to how you approach this. For patients with clear on-going biochemical progression (i.e. the numbers are getting worse but there are no symptoms), we have sometimes used single-agent Revlimid to prevent further progression to symptomatic relapse. Continued close monitoring would also be acceptable, but I hesitate to make any definitive recommendations without more information. You should sit down with your oncologist and discuss these issues at length.
Hope this helps. Good luck and let us know what you decide to do!
Pete V.
At this point, you have been off therapy for almost 2 years. As such, any start of new treatment at this point would probably not be construed as a maintenance therapy but treatment of early biochemical relapse. The studies of Revlimid post-transplant started the maintenance therapy typically 3 months after transplant.
In clinical studies, disease progression as monitored by serum free light chains can be defined as follows:
- 50% increase in the difference between involved and uninvolved FLC levels
from the lowest response level, which must also be an absolute increase of at least
10 mg/dL; OR
- 50% increase in the level of involved FLC AND a 50% increase in the ratio of
involved/uninvolved FLC from the lowest response level.
Your light chains are being measured in mg/L not mg/dL -- correct me if I am wrong.
As such, the increase in the difference of affected and unaffected light chains is just barely >50% (22.7 mg/L to 36.1 mg/L) but the absolute increase has not been enough to declare disease progression (if you were participating in a study). You also do not meet criteria for progression based on the second measure.
Realize that these definitions are imperfect and every case must be evaluated individually. In your case, the disease has only minimally changed over a 1 and a half period of time. As such, you have flexibility as to how you approach this. For patients with clear on-going biochemical progression (i.e. the numbers are getting worse but there are no symptoms), we have sometimes used single-agent Revlimid to prevent further progression to symptomatic relapse. Continued close monitoring would also be acceptable, but I hesitate to make any definitive recommendations without more information. You should sit down with your oncologist and discuss these issues at length.
Hope this helps. Good luck and let us know what you decide to do!
Pete V.
-
Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Should I start maintenance? Other treatment?
Dear Dr. Voorhees,
Thank you very much for your detailed answer to my question. I will be meeting with my hematologist/oncologist in early December and I will discuss everything with him at that time. I appreciate the time you took to answer my question!
Earl McKenzie
Thank you very much for your detailed answer to my question. I will be meeting with my hematologist/oncologist in early December and I will discuss everything with him at that time. I appreciate the time you took to answer my question!
Earl McKenzie
-
coopershawk - Who do you know with myeloma?: No one else.
- When were you/they diagnosed?: August 2010
- Age at diagnosis: 64
3 posts
• Page 1 of 1
Return to Treatments & Side Effects