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Incredible treatment response ... or misdiagnosis?

by ninja performance on Tue Sep 30, 2014 5:02 pm

I have a friend, same age as me (46). I have known him for 4 years. He gets blood tests often because he his taking long term pain meds for back pain from an injury 8 years ago.

He messages me 11 p.m. one Friday night last month telling me that the doctor who did his labs told him he should see his primary care physician on Monday. This was his CBC:

HGB 7.1
HCT 22
Platelets 177
RBC 2.26
WBC 3.2
RDW 15.8

I told him I can't believe this doctor told him to wait until that Monday to see his primary due to an HGB of 7.1, and that he needed to get to the hospital RIGHT NOW, and I guaranteed him they would admit him and start transfusions.

Sure enough, he heeded my warning and went right then and they admitted him and gave him blood.

After seeing some of his other test results, I told him I had a feeling he had multiple myeloma, and I also told him to see a specialist. I said e needed SPEP and a bone marrow biopsy. This is what his results were:

Immoglobulin A 8441
M-spike is 7.5
85% bone marrow plasma cell involvement
Bone scan also showed many bone lesions

They started him on a 2 week on, 1 week off chemo cycle. This is his therapy done twice a week.

Vitamin B12 1000mcg
Aloxi (palonosetron) 250 mcg
Dexamethasone (Decadron) 20 mg
Velcade (bortezomib) 2.1 mg
Cytoxan (cyclophosphamide) 815 mg

After just one 2 week cycle he had another CBC and SPEP.

This is where it gets very strange. His new tests would lead one to believe he went from Stage 3 multiple myeloma into remission after just 2 weeks of therapy.

I told him I am stumped. In my opinion, either his first tests are wrong, or his second tests are wrong. Or is this possible?

After just 2 weeks therapy, SPEP and CBC:

M Spike 0.0
HGB 11.7
HCT 34.2
Platelets 226
RBC 3.74
WBC 5.6
RDW 16.7

ninja performance
Name: Chris Hill
Who do you know with myeloma?: Self
When were you/they diagnosed?: 08/04/2011
Age at diagnosis: 43

Re: Incredible treatment response ... or misdiagnosis?

by Dr. Jason Valent on Wed Oct 01, 2014 8:23 am

I would certainly want to repeat the second set of labs. The misdiagnosis seems very unlikely, as the bone marrow biopsy essentially confirmed what was seen in the labs.

IgA immunoglobulin has a shorter survival time in the serum (commonly called a "half life") than IgG immunoglobulins, so early responses to therapy can be detected with serum IgA measurements. To completely eliminate detectable monoclonal IgA in 2 weeks, however, is pretty rare, although not impossible.

Dr. Jason Valent
Name: Jason Valent, M.D.
Beacon Medical Advisor

Re: Incredible treatment response ... or misdiagnosis?

by Wayne K on Wed Oct 01, 2014 10:48 am

While I don't know my exact time frame, I had a very fast response to Velcade + prednisone. My numbers were close to normal in 30 days.

Wayne K
Name: Wayne
Who do you know with myeloma?: Myself, my sister who passed in '95
When were you/they diagnosed?: 03/09
Age at diagnosis: 70

Re: Incredible treatment response ... or misdiagnosis?

by blair77 on Wed Oct 01, 2014 11:27 am

My husband is IgA and was diagnosed with an M-spike of 1.8 g/dL on April 2, 2013 and had a 0.0 M-spike by the first retest on June 1, 2013. So his M spike was gone by the first time he was tested again.

blair77
Who do you know with myeloma?: My husband
When were you/they diagnosed?: April 2013
Age at diagnosis: 43


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