[Hockeyfan]

Should I start treatment?

by Hockeyfan on Thu Jul 16, 2015 9:22 am

Hi Everyone,

I am a 54 year old male and concerned about whether I should be starting chemo very soon.

Here are selected lab results:

Serum Levels:

Albumin 35 g/L
Free Kappa 309.4 mg/L
Free Lambda 4.4 mg/L
Kappa Lambda Ratio 70.3
Haemoglobin 141 g/L
Platelets 244 g/L
Erythrocytes 4.57 * 10^12 / L
Hematocrit 0.421
Leukocytes 9.9
MPV 8.6
Calcium 2.24 mmol/L
Urea 8.9 mmol/L

Urine Levels:

Bence Jones Protein <0.05 g/L

Skeletal Survey:

Small lytic lesions on skull, one on iliac crest, one on humerus, fracture of vertebral body at T5.

Bone Marrow Aspiration:

"Only occasional bone marrow particles obtained ... scattered plasma cells noted and they appear to constitute less than 5% of the bone marrow"


My concern is that with the 5% level of plasma cells in the bone marrow, is it too early to start chemo? Or do the presence of lytic lesions and the other results expressly indicate that treatment should begin as soon as possible?

Thank you!

[TerryH]

Re: Should I start treatment?

by TerryH on Thu Jul 16, 2015 8:50 pm

Hello Hockeyfan,

A decision about treatment is really one that you need to make in consultation with a doctor, preferably a hematologist-oncologist who specializes in multiple myeloma and related plasma cell disorders.

You've got several signs consistent with the presence of multiple myeloma. Those include your elevated kappa free light chains -- and somewhat suppressed lambda free light chains -- which together lead to a much higher than normal kappa/lambda ratio.

More importantly, you apparently have lytic lesions, and even a fracture. Given your free light chain results, these plausibly could be due to multiple myeloma. If that were the case, you would meet the "B" (bone lesions or fractures) in the traditional "CRAB" criteria for a multiple myeloma diagnosis. That would indicate that treatment is the appropriate next step.

However, the lesions really have to clearly be due to multiple myeloma for them to be considered a symptom of the disease. The free light chain levels suggest the lesions probably are due to the myeloma, but then you have the fact that your calcium level is still in the normal range (I think), and you don't have any anemia. Your bone marrow biopsy also showed only a low plasma cell percentage, but myeloma can be "patchy", so you can't draw a definitive conclusion from that.

Have you recently had a serum protein electrophoresis (SPEP), serum immunofixation (IFE), or testing of your total immunoglobulin levels (IgA, IgG, IgM, etc.)? If so, what did those tests show?

Also, how long have you been monitoring your myeloma? Are these results the first you've ever received, or do you have previous test results?

Finally, have you had your blood (serum) creatinine level tested? Creatinine levels reflect your kidney's health, and kidney (renal) function is the "R" in the CRAB criteria.

Regardless of the answers to the questions I've asked, you certain have results that merit a serious discussion with a myeloma specialist.

You can read more about the criteria for a myeloma diagnosis in this article,

https://myelomabeacon.org/news/2014/10/26/new-multiple-myeloma-diagnostic-criteria/

The Wikipedia article on multiple myeloma also has a section on diagnostic criteria which is helpful and not too hard to understand. The criteria listed in the article are not completely up to date, which is why you also should read the article I mention above.

https://en.wikipedia.org/wiki/Multiple_myeloma#Diagnostic_criteria

I hope that you and your doctors determine, in the end, that there are other, less serious reason than multiple myeloma behind the lab results you've shared with us. If any of us here in the forum can be of further help, though, just let us know.

Good luck!