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Re: Anyone with t(4;14) who did NOT do an SCT upfront?
Banrelk,
So, are your BMBs coming back clean and showing no malignant plasma cells at all? Or are you saying that your BMB still shows the presence of multiple myeloma, but no -17p abnormalities are being detected in these samples?
In any case, it must be heartening news for you. Congrats.
So, are your BMBs coming back clean and showing no malignant plasma cells at all? Or are you saying that your BMB still shows the presence of multiple myeloma, but no -17p abnormalities are being detected in these samples?
In any case, it must be heartening news for you. Congrats.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Anyone with t(4;14) who did NOT do an SCT upfront?
Just a note. Had the SCT about one year ago. I am t(4;14) also. One month before the SCT, my 24-hour urine test was negative, the bone marrow biopsy was less than 1%, all Ig's were normal, skeletal bone scan was normal, and the bone marrow biopsy could not detect t(4:14), so the clinic had the California lab send the original biopsy to my present clinic to confirm the original tests. The original test slides showed t(4:14). However, I still have a small m spike. The M-spike never went to zero. So explain this!
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brandywine - Name: brandywine
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: May 2013
- Age at diagnosis: 67
Re: Anyone with t(4;14) who did NOT do an SCT upfront?
Brandywine,
I have had no M-spike for a number of months now and my IgA has been normal for several months, too. Still, my specialist does not put me at complete response. Because I am IgA, my specialist told me that she does not think the M-spike is of primary importance because it is so difficult to measure accurately in IgA cases. She is more concerned with the involved IgA number and also looks to the immunofixation test result.
So far, my IFE has shown a trace band of myeloma, which I hope will disappear altogether pretty soon. I am wondering whether you are,in fact, in complete response, notwithstanding the presence of a small M-spike? What do your doctors say about this?
I have had no M-spike for a number of months now and my IgA has been normal for several months, too. Still, my specialist does not put me at complete response. Because I am IgA, my specialist told me that she does not think the M-spike is of primary importance because it is so difficult to measure accurately in IgA cases. She is more concerned with the involved IgA number and also looks to the immunofixation test result.
So far, my IFE has shown a trace band of myeloma, which I hope will disappear altogether pretty soon. I am wondering whether you are,in fact, in complete response, notwithstanding the presence of a small M-spike? What do your doctors say about this?
Re: Anyone with t(4;14) who did NOT do an SCT upfront?
Brandywine,
Regarding
So, I hadn't really thought about this kind of phenomenon that much until today. I'm not a doc, but I think that your t(4:14) disappearance prior to your SCT (even when your still have a small M-spike) could be partially explained by the whole notion of "clonal tides", where different clonal lines ebb and flow in both their numbers and dominance over time. This journal article discusses it:
N Bahlis, "Darwinian evolution and tiding clones in multiple myeloma," Blood, Aug 2, 2012 (full text of article)
I'm not clear that clonal lines with a particular kind of mutation such as t(4;14) or del -17p ever really go away completely. But I can imagine a situation where, if the malignant cells in your bone marrow had been sufficiently reduced by your drug treatment leading up to the SCT AND the t(4:14) clonal line had retreated into a less dominant role relative to other clonal lines, then the t(4;14) mutation might not register on your BMB FISH results (in spite of having a small M-spike)? And, of course, the FISH measurement that was part of your BMB could have also been influenced by just how rich or poor of a disease pocket you might have hit with the BMB.
Again, I'm not a doc, and I will be the first to admit that I may not be spot on with my thinking here.
Regarding
Just a note. Had the SCT about one year ago. I am t(4;14) also. One month before the SCT, my 24-hour urine test was negative, the bone marrow biopsy was less than 1%, all Ig's were normal, skeletal bone scan was normal, and the bone marrow biopsy could not detect t(4:14), so the clinic had the California lab send the original biopsy to my present clinic to confirm the original tests. The original test slides showed t(4:14). However, I still have a small m spike. The M-spike never went to zero. So explain this!"
So, I hadn't really thought about this kind of phenomenon that much until today. I'm not a doc, but I think that your t(4:14) disappearance prior to your SCT (even when your still have a small M-spike) could be partially explained by the whole notion of "clonal tides", where different clonal lines ebb and flow in both their numbers and dominance over time. This journal article discusses it:
N Bahlis, "Darwinian evolution and tiding clones in multiple myeloma," Blood, Aug 2, 2012 (full text of article)
I'm not clear that clonal lines with a particular kind of mutation such as t(4;14) or del -17p ever really go away completely. But I can imagine a situation where, if the malignant cells in your bone marrow had been sufficiently reduced by your drug treatment leading up to the SCT AND the t(4:14) clonal line had retreated into a less dominant role relative to other clonal lines, then the t(4;14) mutation might not register on your BMB FISH results (in spite of having a small M-spike)? And, of course, the FISH measurement that was part of your BMB could have also been influenced by just how rich or poor of a disease pocket you might have hit with the BMB.
Again, I'm not a doc, and I will be the first to admit that I may not be spot on with my thinking here.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Anyone with t(4;14) who did NOT do an SCT upfront?
My multiple myeloma specialist response was sent to my online chart: the results are just OK, come back in 8 months. My local oncologist said: you know the m-spike should be zero. If the m-spike goes up, I will add another therapy to the Velcade maintenance. Needless to say that, sounds like VGPR. Not much technical information, but I am a patient, not a scientist.
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brandywine - Name: brandywine
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: May 2013
- Age at diagnosis: 67
Re: Anyone with t(4;14) who did NOT do an SCT upfront?
Brandywine,
It does sound like you should be happy with your response thus far, which is the bottom line after all
It does sound like you should be happy with your response thus far, which is the bottom line after all
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Anyone with t(4;14) who did NOT do an SCT upfront?
Multibilly,
My most recent BMB, January 2015, says "No evidence of residual plasma cell myeloma", and "stain for CD138 shows 1% plasma cells", plus "no evidence of clonality", with no mention of -17p.
It's been a while since the oncologist and I have discussed the absence of -17p, but I'll try to get a review of his thoughts again (to update my memory) when I see him next month. He's at the ASCO conference today and I think the abstract he and a few others have put together on the daratumumab clinical trial should be available online at "abstract.asco.org" sometime today or tomorrow.
Cheers,
Banrelk4
My most recent BMB, January 2015, says "No evidence of residual plasma cell myeloma", and "stain for CD138 shows 1% plasma cells", plus "no evidence of clonality", with no mention of -17p.
It's been a while since the oncologist and I have discussed the absence of -17p, but I'll try to get a review of his thoughts again (to update my memory) when I see him next month. He's at the ASCO conference today and I think the abstract he and a few others have put together on the daratumumab clinical trial should be available online at "abstract.asco.org" sometime today or tomorrow.
Cheers,
Banrelk4
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Banrelk4 - Name: E.C.
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Oct 2010
- Age at diagnosis: 73
Re: Anyone with t(4;14) who did NOT do an SCT upfront?
My attention was caught by the reference to the 2015 ASCO poster presentation No. 8530 from Columbia University researchers. Essentially, the results of a randomized, phase III trial are that Revlimid and low dose dexamethasone (Rd) is equivalent to Rd plus ASCT in newly diagnosed multiple myeloma patients. I am not entirely sure how meaningful this research is and would welcome input from others.
Re: Anyone with t(4;14) who did NOT do an SCT upfront?
Hi Mrozdav,
I agree that the study you mention is an interesting one. There are, however, a couple of "gotchas" when it comes to interpreting the results.
First, the study doesn't do quite the comparison one might think it's doing. One group of patients got 8 cycles of Revlimid plus dex, then maintenance dex. The other group got 4 cycles of Revlimid plus dex, a transplant, and then maintenance dex.
So what you're really comparing is whether 4 extra cycles of Revlimid and dex gives you the same benefit as a transplant.
Second, I've wondered whether this aspect of the trial also is important:
"Patients with stable disease prior to stem-cell collection, or with progressive disease at any time, went off study."
Basically, they built into the study a condition where the study would only be conducted with patients who respond to Revlimid and dex. Patients, for example, who might need Velcade to deepen their response – and who might therefore have benefited from the additional depth of response a transplant might give – were by design excluded from continuing on the trial.
Still, it's an interesting study.
I agree that the study you mention is an interesting one. There are, however, a couple of "gotchas" when it comes to interpreting the results.
First, the study doesn't do quite the comparison one might think it's doing. One group of patients got 8 cycles of Revlimid plus dex, then maintenance dex. The other group got 4 cycles of Revlimid plus dex, a transplant, and then maintenance dex.
So what you're really comparing is whether 4 extra cycles of Revlimid and dex gives you the same benefit as a transplant.
Second, I've wondered whether this aspect of the trial also is important:
"Patients with stable disease prior to stem-cell collection, or with progressive disease at any time, went off study."
Basically, they built into the study a condition where the study would only be conducted with patients who respond to Revlimid and dex. Patients, for example, who might need Velcade to deepen their response – and who might therefore have benefited from the additional depth of response a transplant might give – were by design excluded from continuing on the trial.
Still, it's an interesting study.
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