I had a stem cell transplant in May 2014 after 4 rounds of VRD (Velcade, Revlimid, dex). My M-spike prior to SCT was 0.24 g/dL (2.4 g/L) and after SCT, at 100 days, it was 0.41g/dL.
I was very concerned that the stem cell transplant failed because of the increase in M-spike. Although I was told that I had a very good partial response overall, based on the M-spike decreasing since October 2013, which had been around 1.9 g/dL, I wasn't given a determination on the SCT success.
Also, I was told that the 100 day m spike (0.41) had some background paraproteins, so was reported as higher and therefore could not be compared to pre-transplant m spike to determine whether transplant was successful or not.
Has anyone else out there been told that M-pike comparisons are like apples and oranges? If so, what criteria was your SCT success / failure based on?
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Re: Criteria for assessing stem cell transplant success?
The M-spike on SPEP is just part of the response assessment post-transplant, which also typically includes serum immunofixation, serum free light chains, 24 hour urine for UPEP and immunofixation, and often a bone marrow biopsy. We look at all of these parameters together to determine the overall response post-transplant.
Sometimes early on after transplant there can be other paraproteins that emerge on the SPEP and immunofixation that can cloud the picture and make it difficult to accurately quantitate the M-spike. This is related to the immune system's recovery and is called oligoclonal reconstitution. These other proteins eventually fade away, but this can take 6-12 months sometimes, during which it may be difficult to interpret the SPEP (M-spike).
It's also important to remember that a complete remission isn't absolutely required for the SCT to be considered a "success." Many patients have low-level residual M-spikes after SCT and have durable remissions, which can often be extended further with maintenance therapy after the SCT.
These are all good things to discuss with your oncologist going forward.
Sometimes early on after transplant there can be other paraproteins that emerge on the SPEP and immunofixation that can cloud the picture and make it difficult to accurately quantitate the M-spike. This is related to the immune system's recovery and is called oligoclonal reconstitution. These other proteins eventually fade away, but this can take 6-12 months sometimes, during which it may be difficult to interpret the SPEP (M-spike).
It's also important to remember that a complete remission isn't absolutely required for the SCT to be considered a "success." Many patients have low-level residual M-spikes after SCT and have durable remissions, which can often be extended further with maintenance therapy after the SCT.
These are all good things to discuss with your oncologist going forward.
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
Re: Criteria for assessing stem cell transplant success?
Hello Dr. Cohen,
Thank you so much for taking the time to respond. It cleared up the hazy M-spike picture for me and will discuss with my oncologist.
Just to note, I didn't have a 24-hour urine nor a bone marrow biopsy and now am on Revlimid 10 mg. My M-spike during first round and two weeks in was 0.30 g/dL (3.0 g/L), so it has decreased from the 0.41 but not to level of pre SCT(0.24). Hopefully it will remain low here on out. I'm keeping my fingers crossed!
Thank you so much for taking the time to respond. It cleared up the hazy M-spike picture for me and will discuss with my oncologist.
Just to note, I didn't have a 24-hour urine nor a bone marrow biopsy and now am on Revlimid 10 mg. My M-spike during first round and two weeks in was 0.30 g/dL (3.0 g/L), so it has decreased from the 0.41 but not to level of pre SCT(0.24). Hopefully it will remain low here on out. I'm keeping my fingers crossed!
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