Husband, Frank, started treatment for multiple myeloma in July 2015. His M spike at diagnosis was 3.4 g/dL (34 g/L).
His M spike numbers dropped to 1.1 g/dL after first treatment cycle and then to 0.7 g/dL and this last was 0.6 g/dL.
Is this initial sharp decline in M spike numbers often followed by very slow decline in numbers? Also, can anyone give me their experience with length of time it took for their numbers to reach 0.0? Is it common for multiple myeloma patients with "standard" or average risk factors to even reach the 0.0 level?
His drug therapy consists of 10 mg Revlimid, Velcade, and dexamethasone.
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Foxrun - Name: Carole
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: June 22 2015
- Age at diagnosis: 71
Re: How long for M-spike to drop to 0 during treatment?
Hello Carol:
There is info out there on response rates, including a number of clinical trials. Typically, they are published in articles from the American Society of Hematology (ASH) or another group called ASCO. There are also Beacon articles summarizing these results.
Just to give you an idea of some round numbers, I recall that M Spike going to zero (also referred to as complete response), is something like 30% based on induction drugs, only. This number I believe is a typical number for RVD, which is the standard of care in the US. M spike going down by 90% is called Very Good Partial Response (VGPR). VGPR or better for RVD is something like 70%, based on induction drugs only. Moving up to ASCT brings these numbers up, but the CR rate for RVD and transplant is still something less than 50%.
Because your starting number at 3.5 is on the low side, it might a little harder to reach VGPR. Your latest number seems to be plateauing, but is near VGPR. I think that a doctor would call this in the range of a "typical" response after 3 or 4 cycles. I say this based only on the M Spike number and some of the published stats. I am sure that your Myeloma Specialist is on top of the other aspects of your husbands case.
My main point to you is that based on current treatments, most people do not make zero M-Spike, i. e. CR. Many doctors then balance if its worthwhile to give more treatment (with more side effects), or just ride it out. Reaching VGPR however, is considered good, and many patients remain in that state of partial remission for a long time. Specifically in your husband's case, you need to discuss with your myeloma specialist how to proceed, but that is the basic tradeoff. Unfortunately, on a case by case basis, it is impossible to predict, so you need to do your research, and make your best decision possible, and hope for the best. Good luck. I hope these basic stats help.
There is info out there on response rates, including a number of clinical trials. Typically, they are published in articles from the American Society of Hematology (ASH) or another group called ASCO. There are also Beacon articles summarizing these results.
Just to give you an idea of some round numbers, I recall that M Spike going to zero (also referred to as complete response), is something like 30% based on induction drugs, only. This number I believe is a typical number for RVD, which is the standard of care in the US. M spike going down by 90% is called Very Good Partial Response (VGPR). VGPR or better for RVD is something like 70%, based on induction drugs only. Moving up to ASCT brings these numbers up, but the CR rate for RVD and transplant is still something less than 50%.
Because your starting number at 3.5 is on the low side, it might a little harder to reach VGPR. Your latest number seems to be plateauing, but is near VGPR. I think that a doctor would call this in the range of a "typical" response after 3 or 4 cycles. I say this based only on the M Spike number and some of the published stats. I am sure that your Myeloma Specialist is on top of the other aspects of your husbands case.
My main point to you is that based on current treatments, most people do not make zero M-Spike, i. e. CR. Many doctors then balance if its worthwhile to give more treatment (with more side effects), or just ride it out. Reaching VGPR however, is considered good, and many patients remain in that state of partial remission for a long time. Specifically in your husband's case, you need to discuss with your myeloma specialist how to proceed, but that is the basic tradeoff. Unfortunately, on a case by case basis, it is impossible to predict, so you need to do your research, and make your best decision possible, and hope for the best. Good luck. I hope these basic stats help.
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JPC - Name: JPC
Re: How long for M-spike to drop to 0 during treatment?
Hi Carole,
I'm so sorry to hear about your husband. But glad you found this site - you are in a good place!
Myeloma behaves very differently in different people. Even people with similar disease profiles can have vastly different responses to treatment. While statistics can tell you what the "average" response rate is, each person's disease is unique. What's most important is how your husband responds and it seems like he's doing great!
Lyn
I'm so sorry to hear about your husband. But glad you found this site - you are in a good place!
Myeloma behaves very differently in different people. Even people with similar disease profiles can have vastly different responses to treatment. While statistics can tell you what the "average" response rate is, each person's disease is unique. What's most important is how your husband responds and it seems like he's doing great!
Lyn
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Christa's Mom - Name: Christa's Mom
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: September, 2010
- Age at diagnosis: 53
Re: How long for M-spike to drop to 0 during treatment?
I was declared stage IIA at Mayo on February 16, 2015. MGUS since thirty years ago (1985).
My test values are:
Feb 16 - Kappa FLC 56.2 K/L FLC ratio 65.2 IgG 5240 M-spike 3.9 g/dL
After three cycle of Revlimid 25 mg, dex 20 mg per week:
Jun 04 - Kappa FLC 28.2 K/L FLC ratio 19.6 IgG 2830 M-spike 2.0 g/dL
After another two cycle of Revlimid plus dex, same dose as above:
Sep 15 - Kappa FLC 11.4 K/L FLC ratio 5.43 IgG 1810 M-spike 1.2 g/dL
I am on my sixth cycle of Revlimid plus dex same dose as above, and expected to go back after two more cycles in January. I had my stem cell harvest for freezing at Mayo from September 15 to 22.
I also got confirmed to be an extreme G6PD - a X chromosome inherited person. My reading for G6PD is less than 0.3 percent where as normal is above 8.
I hope this helps in knowing the rate of M spike going down.
Any one in this forum with knowledge / experience with G6PD person with multiple myeloma?
Thank you.
My test values are:
Feb 16 - Kappa FLC 56.2 K/L FLC ratio 65.2 IgG 5240 M-spike 3.9 g/dL
After three cycle of Revlimid 25 mg, dex 20 mg per week:
Jun 04 - Kappa FLC 28.2 K/L FLC ratio 19.6 IgG 2830 M-spike 2.0 g/dL
After another two cycle of Revlimid plus dex, same dose as above:
Sep 15 - Kappa FLC 11.4 K/L FLC ratio 5.43 IgG 1810 M-spike 1.2 g/dL
I am on my sixth cycle of Revlimid plus dex same dose as above, and expected to go back after two more cycles in January. I had my stem cell harvest for freezing at Mayo from September 15 to 22.
I also got confirmed to be an extreme G6PD - a X chromosome inherited person. My reading for G6PD is less than 0.3 percent where as normal is above 8.
I hope this helps in knowing the rate of M spike going down.
Any one in this forum with knowledge / experience with G6PD person with multiple myeloma?
Thank you.
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MMFeb16,15 - Who do you know with myeloma?: Self
- When were you/they diagnosed?: February 16, 2015
- Age at diagnosis: 66
Re: How long for M-spike to drop to 0 during treatment?
Husband had stem cell transplant done on February 19, 2016. His protein electrophoresis was 0.10 g/dL at 24 days after stem cell transplant. Is there possibility this may drop further over next few weeks?
After six cycles of Revlimid, Velcade, and dexamethasone, his protein level was undetectable.
If protein does not drop further, does this mean the stem cell transplant was not effective?
After six cycles of Revlimid, Velcade, and dexamethasone, his protein level was undetectable.
If protein does not drop further, does this mean the stem cell transplant was not effective?
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Foxrun - Name: Carole
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: June 22 2015
- Age at diagnosis: 71
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