[kbev]

Trying to understand multiple myeloma

by kbev on Thu May 29, 2014 6:22 am

I recently wrote a topic in "treatments" regarding some issues with my mom and multiple myeloma. I spent the evening here reading through the forums and I am very confused about myeloma. I would appreciate any help anyone can give me so I can understand her disease and course of treatment better.

Mom is 75, diagnosed MGUS last year. Diagnosed multiple myeloma in February this year. Has a lesion on her pelvis and spine. Has 50% Myeloma. Has rheumatoid arthritis also. Treatment has been Velcade SubQ weekly with dex added in about a month ago.

Here are the things I don't understand.

I see folks talking about the "kind" of myeloma they has such as IgG etc - I have seen mention of "rare types" of myeloma. What does this mean and is this listed in lab work or do I need to ask her doctor?

What does secretory and non-secretory mean?

I have been focusing on B2M because that number is very high and I do understand this is related to kidney function. I also thought it was measuring the growth of the cancer now I am unsure if that is correct. I see mentions of M Spike and I can see that in past lab work they tested my Mom's M spike but they have not been lately. Is the M Spike and B2M rolled into one number?

I have been told by the doctor that she is not responding to Velcade how they had hoped. I do see a decrease in certain numbers and an increase in others. If B2M is related to kidneys and not the cancer it looks to me like the cancer may be decreasing, which would indicate response to Velcade. Here are the numbers I am looking at. The numbers in parenthesis were her number in February before treatment.

IgG - 1164 (feb 1422)
IgA - 239 (277)
IgM - 75 (138)

Abnormal Protein Band - 0.2 (0.3)
Serum Kappa - 52.3 (75.4)
Lambda Light Chain - 31.6 (25.7)***
Kappa/Lambda chain - 1.66 (2.93)
Beta 2 M - 6.27 (5.23)***

Creatine 1.20 (1.11) ***

So we have an increase in lambda Light, Beta 2, and Creatine.

Anyone that can help me understand I would be much appreciative. They are doing one more round of Velcade and if not working they have suggested they may radiate the two lesions. I see other drugs that people are on and am wondering if they should be tried first. At what point do you choose radiation as opposed to trying another drug?

I thank you so much for your help and for the forum - it is helpful to read your stories.

[Cheryl G]

Re: Trying to understand multiple myeloma

by Cheryl G on Thu May 29, 2014 11:49 am

Hope you won't mind if I answer just a few of your questions. Don't have the time right now to answer all of them.

There is an article here at the Beacon that discusses non-secretory myeloma. Here's the link:

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

The "type" of myeloma you refer to has to do with which kind of immunoglobulin the myeloma cells in a patient create. In other words, its the immunoglobulin which is showing a "spike", a much higher than normal level.

The most common type of myeloma is IgG. Other common types IgA and IgM. The types IgD and IgE are rare. This is explained in "Diagnosis" section of the Wikipedia article about myeloma,

http://en.wikipedia.org/wiki/Multiple_myeloma#Diagnosis

The Wikipedia article in general has good, readable information about the disease.

The Wikipedia article on beta 2 microglobulin also may answer some of your questions about it. See, in particular, the section on about B2M's clinical significance:

http://en.wikipedia.org/wiki/Beta-2_microglobulin#Clinical_significance

I'm not a doctor, but I don't think B2M would be described as a key measure of whether or not a myeloma patient is responding to treatment. B2M is definitely important, but I think the M-spike and free light chain levels and ratio are the key measures that doctors use to track the disease and response to treatment.