[DexMed]

Smoldering myeloma - high risk or not based on FLC ratio?

by DexMed on Sun Sep 08, 2013 1:23 pm

At Diagnosis: SMM over 3.5 years ago at age 62. Originally, all CRAB stats were OK (M spike 1.3g/L; No Lesions;slight anemia 12.4 HgB; BM plasma at 13%). IgA was 1700mg/dL; Serum Kappa was very high 9.3mg/dL . The FLC Kappa/Lambda ratio 14.

Currently: No treatments except 125mg elemental iron for iron deficiency.
- All bloodwork has been stable with the exception of Serum FLC ratios.
- The FLC ratio has fluctuated a lot and recently at 96 (normal ratio should be <1.65)
- The absolute value of Kappa has not changed very much..stayed within 10-15mg/dL range
- The ratio has gone up because the Lambda has declined over time.
- I have diabetes for over 20 years and am taking oral medication. ( Prednisone 20 mg for two months made it really bad, when taken previously for misdiagnosed polymialgia rheumatica)

Need help /Question: Do I need to start early treatment? or continue 3-month bloodwork until multiple myeloma symptoms (lesions, renal deficiency etc) develop? Is the high FLC ratio by itself a big risk factor if the absolute value of Kappa has been relatively stable?

[JimNY]

Re: Smoldering myeloma - high risk or not based on FLC ratio

by JimNY on Mon Sep 09, 2013 12:21 am

Hi Vince,

One of the doctors who posts here in the forum, Dr. Shain, also answered some questions recently about high-risk smoldering myeloma. You may find the discussion and some of the links in it helpful:

https://myelomabeacon.org/forum/high-risk-smoldering-t2256.html

Dr. Shain mentions the two main systems for classifying smoldering myeloma in terms of risk of progression -- one is from the Mayo Clinic, the other from the Spanish myeloma group.

These are also explained in this forum thread:

https://myelomabeacon.org/forum/formal-risk-of-progression-classification-for-smoldering-multiple-myeloma-t1542.html

and this research review discusses some research that is looking at how much the two classification systems overlap with one another:

https://myelomabeacon.org/news/2013/01/23/mayo-pethema-risk-of-progression-smoldering-myeloma-more-disagreement-than-agreement/

As you'll see in these discussions and articles, having a FLC ratio outside the range of 0.125 to 8 is one of the risk factors for faster progression in the Mayo Clinic classification. But it's only one -- there are others.

Hope this helps a bit.

[DexMed]

Re: Smoldering myeloma - high risk or not based on FLC ratio

by DexMed on Mon Sep 09, 2013 11:55 pm

Thanks, JimNY. The articles are a great help.

[Dr. Adam Cohen]

Re: Smoldering myeloma - high risk or not based on FLC ratio

by Dr. Adam Cohen on Fri Sep 13, 2013 8:09 am

One thing to remember is that these prognostic factors like abnormal FLC ratio (Mayo) or aberrant plasma cell phenotype (Spanish group) have been studied primarily in patients who are newly- or recently-diagnosed with smoldering myeloma. You have already been stable for 3.5 years (well beyond the median 2 year time to progression predicted for "high-risk" patients), and that fact in my mind is more important than the FLC ratio at this point. As long as you are being watched closely and are not having progressive rise in M-spike, or development of CRAB, there is no data that starting treatment now will be beneficial.
Hope this helps.

[DexMed]

Re: Smoldering myeloma - high risk or not based on FLC ratio

by DexMed on Sat Sep 14, 2013 12:42 am

Thanks so much for your response, Dr Cohen. It did provide some relief to me.