I was diagnosed in January of 2015 and went through Revlimid, Velcade, and dexamethasone (RVD) induction, an autologous stem cell transplant, RVD consolidation, and I am now on Revlimid maintenance.
My doctor told me that she will be carefully watching my MRD. I am trying to understand how relatively high or low my MRD is. On my most recent bone marrow biopsy, I see that "abnormal plasma cells represent 14.3% of total plasma cells in the sample." Is there any way to quantify that number?
Thanks so much for any input,
Rebecca
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RebeccaB - Name: Rebecca
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Jan 2015
- Age at diagnosis: 58
Re: Understanding my minimal residual disease
Rebecca,
You may want to read the article below that was published in the Beacon in 2014. It may not be exactly what you looking for, but will help you to understand minimal residual disease (MRD) and how it impacts progression-free survival.
"Minimal Residual Disease, Deep Sequencing, And Prognosis In Multiple Myeloma," The Myeloma Beacon, April 8, 2014
Those patients that are MRD-negative have the greatest probability of having the longest time until relapse. The higher the percentage of MRD, the less the average length until relapse.
These are statistics only and do not mean that you will have the same result. That is why your doctor will carefully monitor your myeloma to see if you are holding your current level or if it is progressing. Progression or relapse should not cause panic. It simply means that your treatment protocol will be changed to push the disease back down.
You may want to read the article below that was published in the Beacon in 2014. It may not be exactly what you looking for, but will help you to understand minimal residual disease (MRD) and how it impacts progression-free survival.
"Minimal Residual Disease, Deep Sequencing, And Prognosis In Multiple Myeloma," The Myeloma Beacon, April 8, 2014
Those patients that are MRD-negative have the greatest probability of having the longest time until relapse. The higher the percentage of MRD, the less the average length until relapse.
These are statistics only and do not mean that you will have the same result. That is why your doctor will carefully monitor your myeloma to see if you are holding your current level or if it is progressing. Progression or relapse should not cause panic. It simply means that your treatment protocol will be changed to push the disease back down.
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Understanding my minimal residual disease
Short of trying to count every “abnormal plasma cell” in your body, I think the number you have been given is a good one. After all, the amount of abnormal cells needs to be compared to something. Just saying “we found 500 abnormal cells” is close to being meaningless.
However, finding the ratio of abnormal to total plasma cells is a good way to go. There is a direct and meaningful comparison. The ratio must be somewhere between zero and one. The closer to zero, the better off you are. Ideally, you’d like to see this number equal to zero.
It would also be nice to know the number of plasma cells (normal and abnormal) relative to all the non-fat cells in the bone marrow. This would give some perspective on the overall status of the bone marrow. In my case, I found out that 60% of all the cells in my bone marrow sample are plasma cells. It should have been between 1 to 2%. That really got my attention.
It is possible to normalize the number of plasma cells to the volume of bone marrow sample, but I think this number would be prone to error and I am not sure what further insight this would give, especially when one considers sampling errors. By normalize, I mean express the number density of the abnormal plasma cells as the number of abnormal plasma cells per volume of marrow.
I hope this helps.
However, finding the ratio of abnormal to total plasma cells is a good way to go. There is a direct and meaningful comparison. The ratio must be somewhere between zero and one. The closer to zero, the better off you are. Ideally, you’d like to see this number equal to zero.
It would also be nice to know the number of plasma cells (normal and abnormal) relative to all the non-fat cells in the bone marrow. This would give some perspective on the overall status of the bone marrow. In my case, I found out that 60% of all the cells in my bone marrow sample are plasma cells. It should have been between 1 to 2%. That really got my attention.
It is possible to normalize the number of plasma cells to the volume of bone marrow sample, but I think this number would be prone to error and I am not sure what further insight this would give, especially when one considers sampling errors. By normalize, I mean express the number density of the abnormal plasma cells as the number of abnormal plasma cells per volume of marrow.
I hope this helps.
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Wobbles - Name: Joe
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: June 2016
- Age at diagnosis: 67
Re: Understanding my minimal residual disease
Hello Rebecca:
Minimal residual disease (MRD) testing and reporting is fairly new, and still has an issue in terms of standardization in testing and reporting. As explained to us for my wife's case at Memorial Sloan Kettering, it is reported in terms of percentage of bad plasma cells as a portion of total white blood cells in a bone marrow biopsy sample. A smear is taken from the aspirate (bloody part) of the bone marrow biopsy, and reviewed under a microscopic optical computer program for the presence of bad myeloma cells. The sample is typically in the range of about 4 million white blood cells.
The International Myeloma Working Group standard is that for minimal residual disease negativity, the number has to be less than one bad plasma cells in every 100,000 thousand white blood cells (aka the 10 ** (-5) standard, written out in words, ten to the minus five standard). For that to occur, there needs to be no more than 40 bad plasma cells in the sample of 4 million white blood cells (I will use the engineering term of parts per million or ppm).
Here is my guess for your situation. It was reported in percent of bad plasma cells out of total plasma cells. After treatment, plasma cells get suppressed. They could be normally in the range of 2% to 4%, but the treatment typically lowers it, so lets assume that your % plasma cells is at 1% of all white blood cells. Then your % of bad plasma cells out of total white blood cells is 1% of 14%, which comes out to be 0.014 %. That comes out to be 1,400 cells out of a million (or 1,400 ppm). If your percentage of plasma cells out of total white cells was different than 1%, you would adjust the calculation for your ppm of bad plasma cells accordingly.
This is just my guess, but I am trying to give you some basis to go back to your doctor for discussion. You want him or her to explain where you stand in terms of the IMWG standard of ten to the minus five. Some centers are also trying to get good enough samples to evaluate the MRD on the more stringent ten to the minus six standard.
Historically, it was found that for people in traditional complete response (CR), about half of them were MRD positive. Hence, the idea of the more sensitive test, as a finer way to see if the multiple myeloma was driven down as low as possible. It was found that for patients who had CR but MRD positive, that results were not as good as for patients who were CR but MRD negative. Very interestingly, a small portion of patients reach MRD negative before they reach CR. My wife was negative by the ten to the minus five standard, before her M-spike went away, on Kyprolis, Revlimid, and dexamethasone (KRD) consolidation after Velcade, Revlimid, and dexamethasone (VRD) induction and an autologous stem cell transplant.
Hope this helps. Good luck to you.
Minimal residual disease (MRD) testing and reporting is fairly new, and still has an issue in terms of standardization in testing and reporting. As explained to us for my wife's case at Memorial Sloan Kettering, it is reported in terms of percentage of bad plasma cells as a portion of total white blood cells in a bone marrow biopsy sample. A smear is taken from the aspirate (bloody part) of the bone marrow biopsy, and reviewed under a microscopic optical computer program for the presence of bad myeloma cells. The sample is typically in the range of about 4 million white blood cells.
The International Myeloma Working Group standard is that for minimal residual disease negativity, the number has to be less than one bad plasma cells in every 100,000 thousand white blood cells (aka the 10 ** (-5) standard, written out in words, ten to the minus five standard). For that to occur, there needs to be no more than 40 bad plasma cells in the sample of 4 million white blood cells (I will use the engineering term of parts per million or ppm).
Here is my guess for your situation. It was reported in percent of bad plasma cells out of total plasma cells. After treatment, plasma cells get suppressed. They could be normally in the range of 2% to 4%, but the treatment typically lowers it, so lets assume that your % plasma cells is at 1% of all white blood cells. Then your % of bad plasma cells out of total white blood cells is 1% of 14%, which comes out to be 0.014 %. That comes out to be 1,400 cells out of a million (or 1,400 ppm). If your percentage of plasma cells out of total white cells was different than 1%, you would adjust the calculation for your ppm of bad plasma cells accordingly.
This is just my guess, but I am trying to give you some basis to go back to your doctor for discussion. You want him or her to explain where you stand in terms of the IMWG standard of ten to the minus five. Some centers are also trying to get good enough samples to evaluate the MRD on the more stringent ten to the minus six standard.
Historically, it was found that for people in traditional complete response (CR), about half of them were MRD positive. Hence, the idea of the more sensitive test, as a finer way to see if the multiple myeloma was driven down as low as possible. It was found that for patients who had CR but MRD positive, that results were not as good as for patients who were CR but MRD negative. Very interestingly, a small portion of patients reach MRD negative before they reach CR. My wife was negative by the ten to the minus five standard, before her M-spike went away, on Kyprolis, Revlimid, and dexamethasone (KRD) consolidation after Velcade, Revlimid, and dexamethasone (VRD) induction and an autologous stem cell transplant.
Hope this helps. Good luck to you.
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JPC - Name: JPC
4 posts
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