[positive thoughts]

Tracking nonsecretory multiple myeloma response to therapy

by positive thoughts on Tue Jun 15, 2010 10:41 am

Accepting the fact that nonsecretory multiple myeloma does not leave much of a trail, how does a physician treating patients with nonsecretory multiple decide what scans, blood test, etc are the most useful in identifying how the patient is responding to therapy and, if any are useful, what exacting do they show that makes them so.

At various times duriung my nonscretory multiple myeloma diagosis and treatment I have had x-rays,total body scan / skeletal survey, whole bone body scan, MRI of cervical, thoracic, lumbar (4 scans over 2 year period) CT scan & PET/CT scan skull to hips (2 scans over 1 year)

As for blood test I have the following monthly blood draws:

• CBC w/Diff w/Plt
• Complete Metabolic Panel
• Serum Protein Electrophorsis (SPEP)
• Immunoglobulins Quantitative
• Beta-2 Microglobulins
• Serum Free Light Chain

My IFE Interpretation is routinely "Negative for monoclonal gammopathy"

I have been treated with some radiation and chemotherapy. I have not had a transplant.

Back to my original question and based on your knowledge and experience, what scans, blood test, etc are the most useful in identifying how the nonsecretory patient is responding to therapy and, if any are useful, what exactly do they show that makes them so.

Thanks for any response.

Moderator Note - Readers interested in this topic may want to review an extensive article on nonsecretory myeloma by Beacon physician columnist Dr. Bijay Nair:

https://myelomabeacon.org/headline/2011/10/21/nonsecretory-multiple-myeloma/

[Dr. James Berenson]

Re: Tracking nonsecretory multiple myeloma

by Dr. James Berenson on Thu Jun 24, 2010 9:54 am

Obviously, the first thing to do is see if there is enough free light chain in your blood to be detected and monitored.

If not, then it is very difficult to follow a patient with nonsecretory myeloma. One would only be able to do periodic bone marrow biopsies and X-rays, although these are certainly not accurate ways to follow myeloma.

Obviously, if you should develop kidney problems or difficulty with your blood counts, this could also suggest progression of your myeloma. However, it would be important to obtain a bone marrow biopsy to see how much infiltration has occurred with the malignant plasma cells in order to confirm progression.

That being said, it is important to recognize also, though, that myeloma is a “spotty” disease and plasma cells in one area of the bone marrow are not necessarily indicative of the total bone marrow infiltration with plasma cells.

[Keep the Faith]

Re: Tracking nonsecretory multiple myeloma

by Keep the Faith on Tue Dec 14, 2010 12:00 pm

Given that nonsecretory multiple myeloma is hard to track could you provide your opinion of what tests or scans can provide a useful view as to the efficacy of a treatment program and status of disease.

Your opinion of:

Serum free light chain tTest - how useful?

PET/CT scan - how useful?

MRI - how useful?

In your practice what do you find most useful in tracking nonsecretory multiple myeloma?

Thanks and regards,

[Dr. Philip McCarthy]

Re: Tracking nonsecretory multiple myeloma

by Dr. Philip McCarthy on Wed Dec 15, 2010 4:11 pm

Dear Keep the Faith,

Serum free light chain (SFLC) testing can be very useful for nonsecretory multiple myeloma if the SFLC are present so as to represent disease. That is a very big if ... If the SFLC are not present even with active myeloma on other testing, then this test is not helpful. However, there are some cases of "nonsecretory" multiple myeloma that can be monitored by SFLC in the same manner the monoclonal protein (M protein) can be followed in the blood and urine.

PET Scan with or without CT can be useful in the absence of other blood or urine markers but will depend on the location and extent of disease.

The same is true for MRI.

If one of these tests demonstrates disease that changes in size or activity with therapy then either could be a reasonable test.

Bone marrow tests can be done but multiple myeloma can be aggregate in some areas and not in others and be "patchy" in nature. So, this could be a useful test but usually is not done very frequently as it is more invasive.

Usually we can find evidence by SFLC of multiple myeloma but if the disease is truly non-secretory then a combination of clinical symptoms, clinical examination, bone marrow testing, serum immunoglobulin levels (these can go down with multiple myeloma infiltration of the bone marrow), plain X ray films and either MRI or PET Scan with or without CT is reasonable for tracking the disease.

[Beacon Staff]

Re: Tracking nonsecretory multiple myeloma

by Beacon Staff on Tue Jan 04, 2011 3:03 pm

More information about the Serum Free Light Chain test can be found in this Beacon article:

Scientists Develop Serum Immunoglobulin Free Light Chain Assay For Early Myeloma Diagnosis

[Carla63]

Re: Tracking nonsecretory multiple myeloma

by Carla63 on Wed Feb 02, 2011 11:04 am

Do you know if SFLC examination is a standard one everywhere in the world or it could depend on the different laboratories? I have experienced different result on test done in Boston at DFCI and in Italy in a same time frame.

I have a nonsecretory multiple myeloma and the serum free light chain test is the most important and fast indicator of my cancer. I 'd like to' be' sure about the result.

Thanks in advance