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Re: Myeloma traces returning after stem cell transplant
Thanks, Terry. I tried to send you an email but it wouldn't let me. I have posted my husband's beginning and his last tests.
Re: Myeloma traces returning after stem cell transplant
There are a number of things that can be happening in the situation.
As earlier posts have noted, in some individuals the low tumor burden can bounce in and out of detectable levels. It is important to remember that multiple myeloma is essentially incurable today and that even CRs and sCR -- meaning no evidence of disease -- only mean that the myeloma has been reduced to levels bellow our ability to detect it.
So, myeloma is always there. However, control is the most important aspect - keeping the disease at low levels (detectable or not). WIth new technologies -- such as Next Gen Sequencing, multiparameter flow and PCR --we are trying to improve our ability to detect smaller amounts of disease.
Many patients walk around for years and years with detectable disease after transplant.
Further, the high-dose melphalan can continue to cause reductions in myeloma numbers for months. In other cases, there is reactive or oligoclonal reconstitution of one's immune system that causes what looks like an M-spike- a hint may be in the polyclonal reactive bands noted on the immunofixation (IFE). This oligoclonal band is generally not the same as your diagnostic M-spike (for instance, IgA now instead of an IgG diagnosis). This disappears with time and has been associated with improved outcomes (usually seen 6-12 months).
Relapse always has to be a concern -- even this early -- albeit rare. But there are a lot of other potential and not as anxiety provoking reasons as well.
Make sure that you mention the hip pain to your MDs so that they may reconsider the bone survey or more focused film of the hip.
We wish you both luck and keep everyone posted.
As earlier posts have noted, in some individuals the low tumor burden can bounce in and out of detectable levels. It is important to remember that multiple myeloma is essentially incurable today and that even CRs and sCR -- meaning no evidence of disease -- only mean that the myeloma has been reduced to levels bellow our ability to detect it.
So, myeloma is always there. However, control is the most important aspect - keeping the disease at low levels (detectable or not). WIth new technologies -- such as Next Gen Sequencing, multiparameter flow and PCR --we are trying to improve our ability to detect smaller amounts of disease.
Many patients walk around for years and years with detectable disease after transplant.
Further, the high-dose melphalan can continue to cause reductions in myeloma numbers for months. In other cases, there is reactive or oligoclonal reconstitution of one's immune system that causes what looks like an M-spike- a hint may be in the polyclonal reactive bands noted on the immunofixation (IFE). This oligoclonal band is generally not the same as your diagnostic M-spike (for instance, IgA now instead of an IgG diagnosis). This disappears with time and has been associated with improved outcomes (usually seen 6-12 months).
Relapse always has to be a concern -- even this early -- albeit rare. But there are a lot of other potential and not as anxiety provoking reasons as well.
Make sure that you mention the hip pain to your MDs so that they may reconsider the bone survey or more focused film of the hip.
We wish you both luck and keep everyone posted.
-
Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
12 posts
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