I've been reviewing my husband's lab reports. When he was on Velcade/Dex, his M-Spike was low (either 0.2 g/dl, 0.3 g/dl or zero) and his Free Kappa Light Chains were within the range and on the low side.
He is now on Revlimid/Dex, maintenance, and his M-Spike is zero but his Free Kappa Light Chains are now high - outside the range. The Revlimid is obviously doing something because the M-Spike remains undetectable, but why are the Kappa Light Chains high?
I have requested a Beta 2 Microglobulin test, thinking it might provide some additional information.
Any observations appreciated!
Forums
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Sarah - Name: Sarah
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: October 7, 2010
- Age at diagnosis: 72
Re: Variance in M-Spike and Free Kappa Light Chains
Dear Sarah,
The serum free light chains can be affected by a number of different variables, including kidney function, variability from one testing center to another, etc. What is the exact kappa light chain result pre- and post-Revlimid (lenalidomide) and dex? Also, what are the serum free lambda light chain concentration and the free light chain ratio doing?
Thanks!
Pete V.
The serum free light chains can be affected by a number of different variables, including kidney function, variability from one testing center to another, etc. What is the exact kappa light chain result pre- and post-Revlimid (lenalidomide) and dex? Also, what are the serum free lambda light chain concentration and the free light chain ratio doing?
Thanks!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Variance in M-Spike and Free Kappa Light Chains
Dr. Voorhees: Thanks for responding, and I apologize for the length of my reply.
Bob's last Velcade was 5/24/11, and at that time his M-Spike was zero and the Light Chains were as follows:
Kappa - 6.36 mg/L
Lambda - 6.97 mg/L
Ratio - .91
In July (off any treatment), his M-Spike went to 0.3 g/dL and the Light Chains were as follows:
Kappa - 8.13 mg/L
Lambda - 6.85
Ratio - 1.19
He began Revlimid (10 mg) and Dex (40 mg) in late August, and early September his M-Spike was 0.2 g/dL and Light Chains really jumped:
Kappa - 26.98 mg/L
Lambda - 17.47
Ratio - 1.54
He responded quickly to the Revlimid. His M-Spike has been zero since mid-October. His December light chains (last report that I have), were as follows:
Kappa - 25.08 mg/L
Lambda - 18.18
Ratio - 1.38
His Serum Immunofixation as of 1/6/12:
IgG - 704 mg/dl (within range)
He was hospitalized much of October, with pneumonia and renal failure and was ill, in December, with Bronchitis. Even though the M-Spike is zero, he doesn't feel well much of the time. I have been concerned that perhaps the M-Spike isn't showing everything.
Again, thanks.
Sarah
Bob's last Velcade was 5/24/11, and at that time his M-Spike was zero and the Light Chains were as follows:
Kappa - 6.36 mg/L
Lambda - 6.97 mg/L
Ratio - .91
In July (off any treatment), his M-Spike went to 0.3 g/dL and the Light Chains were as follows:
Kappa - 8.13 mg/L
Lambda - 6.85
Ratio - 1.19
He began Revlimid (10 mg) and Dex (40 mg) in late August, and early September his M-Spike was 0.2 g/dL and Light Chains really jumped:
Kappa - 26.98 mg/L
Lambda - 17.47
Ratio - 1.54
He responded quickly to the Revlimid. His M-Spike has been zero since mid-October. His December light chains (last report that I have), were as follows:
Kappa - 25.08 mg/L
Lambda - 18.18
Ratio - 1.38
His Serum Immunofixation as of 1/6/12:
IgG - 704 mg/dl (within range)
He was hospitalized much of October, with pneumonia and renal failure and was ill, in December, with Bronchitis. Even though the M-Spike is zero, he doesn't feel well much of the time. I have been concerned that perhaps the M-Spike isn't showing everything.
Again, thanks.
Sarah
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Sarah - Name: Sarah
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: October 7, 2010
- Age at diagnosis: 72
Re: Variance in M-Spike and Free Kappa Light Chains
Dear Sarah,
By blood work, your husband has achieved a nice response to the lenalidomide. Importantly, both the kappa and lambda light chain levels have risen -- the ratio remains normal. Renal failure causes the baseline levels of both light chains to go up. Given what you are describing, I would not be surprised if that is why you saw both light chains rise in October. Not because of myeloma progression.
Myeloma can become "non-secretory," but not commonly If you are worried that the numbers are not reflective of his myeloma activity, you may want to bring that to the attention of his treating physician to see what else should be done diagnostically. The beta2-microglobulin is also affected by kidney function. The worse the kidneys, the higher it is.
I hope this helps. Let us know how things go. Good luck!
Pete V.
By blood work, your husband has achieved a nice response to the lenalidomide. Importantly, both the kappa and lambda light chain levels have risen -- the ratio remains normal. Renal failure causes the baseline levels of both light chains to go up. Given what you are describing, I would not be surprised if that is why you saw both light chains rise in October. Not because of myeloma progression.
Myeloma can become "non-secretory," but not commonly If you are worried that the numbers are not reflective of his myeloma activity, you may want to bring that to the attention of his treating physician to see what else should be done diagnostically. The beta2-microglobulin is also affected by kidney function. The worse the kidneys, the higher it is.
I hope this helps. Let us know how things go. Good luck!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
light chains down from 350 to 1.69
We have opted out of MD Anderson Stem Cell harvest and transplant at this time. He is responding well to Revlimid/Dex mix. What is the next step?
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Jwoods
Re: Variance in M-Spike and Free Kappa Light Chains
Jwoods, with the good response that you have had, progressing to ASCT is not an immediate need studies have shown. However, I am surprised that they didn't recommend doing the stem cell harvest at this time and storing the stem cells for future use. The tumour burden has been reduced significantly and Revlimid has been shown to interfere with the stem cell harvest results.
Continuing with Revlimid and waiting for a relapse to harvest the stem cell may lead to a poorer result. My oncologist runs the Stem Cell Lab and Bone Marrow Transplant Program at the university centre that I attend and they have found that using neupegen and mozobil to mobilize the stem cells has overcome the difficulty created by Revlimid to date. I suggest that you discuss this issue with your doctors as I personally would do the harvest now.
Continuing with Revlimid and waiting for a relapse to harvest the stem cell may lead to a poorer result. My oncologist runs the Stem Cell Lab and Bone Marrow Transplant Program at the university centre that I attend and they have found that using neupegen and mozobil to mobilize the stem cells has overcome the difficulty created by Revlimid to date. I suggest that you discuss this issue with your doctors as I personally would do the harvest now.
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bond007
Re: Variance in M-Spike and Free Kappa Light Chains
JWoods,
I get you about stem cell transplant!!
However, I would do harvest just for a plan B. Harvesting is not transplant...but it does give you the option should you choose to do so later. You would need to harvest conservatively by 5th or 6th cycle. You can always elect for transplant later, as bond007 mentioned.
My only caveat is that stem cell harvesting is an 'art' I would not harvest if at a site that only will do use one of the alkylator agents.(cyclophosamide/melphan/ifosamide) Just my personal opinion. Beware this is part of standard proctocol at many sites. I would select a harvest/ transplant site that does so with perifosine,(an AKt inhibitor) especially if there are any chromosomal translocations/deletions. Especially if TP 53 aka 17p is present.
Alkylators destabilze DNA. Chromosomal changes means that is already present, which means it can potentiate an already deleterious (negative prognosis/pro multiple myeloma) as part of the hi dose SCT protocol or harvesting procedure.. Studies show individuals have far shorter PFS in that patient population.. Even after undergoing (suffering) that grueling procedure, they have significantly worse outcomes.
"Deletion of chromosome 17p13, present in 10% of patients, confers poorer survival. Patients with this deletion who undergo HDT followed by autologous stem cell transplantation (ASCT) have significantly shorter progression-free and overall survival than patients without this deletion."
http://www.jnccn.org/content/8/Suppl_1/S-28.full
"The presence of baseline high-risk cytogenetics by FISH (hazard ratio 17.3; P = .002) and persistent minimal residual disease by multiparameter flow cytometry at day +100 after HDT/ASCT (hazard ratio 8.0; P = .005) were the only independent factors that predicted unsustained CR. Thus, these 2 parameters may help to identify patients in CR at risk of early progression after HDT/ASCT in whom novel treatments should be investigated."
http://www.ncbi.nlm.nih.gov/pubmed/22128143
http://bloodjournal.hematologylibrary.org/content/119/3/687.full
" All patients were conditioned with high-dose melphalan. With a median follow-up of 3.4 years, overall survival and event-free survival at 3 years were significantly worse in high-risk patients (48% vs. 97%; P = 0.0005 and 16% vs. 37%; P = 0.038, respectively) despite the higher CR plus VGPR rate among high-risk patients. In addition, survival at 1 year after progression was significantly worse in high-risk patients despite salvage chemotherapy containing thalidomide (32% vs. 100%, P = 0.0001). Combinations of cytogenetics and ISS could readily predict prognosis. Quality of response is a poor surrogate marker for ultimate outcome. High-risk patients may need more effective treatment"
http://www.ncbi.nlm.nih.gov/pubmed/19338045
http://myeloma.org/ArticlePage.action?articleId=3604
Sending you blessings,
suzierose
I get you about stem cell transplant!!
However, I would do harvest just for a plan B. Harvesting is not transplant...but it does give you the option should you choose to do so later. You would need to harvest conservatively by 5th or 6th cycle. You can always elect for transplant later, as bond007 mentioned.
My only caveat is that stem cell harvesting is an 'art' I would not harvest if at a site that only will do use one of the alkylator agents.(cyclophosamide/melphan/ifosamide) Just my personal opinion. Beware this is part of standard proctocol at many sites. I would select a harvest/ transplant site that does so with perifosine,(an AKt inhibitor) especially if there are any chromosomal translocations/deletions. Especially if TP 53 aka 17p is present.
Alkylators destabilze DNA. Chromosomal changes means that is already present, which means it can potentiate an already deleterious (negative prognosis/pro multiple myeloma) as part of the hi dose SCT protocol or harvesting procedure.. Studies show individuals have far shorter PFS in that patient population.. Even after undergoing (suffering) that grueling procedure, they have significantly worse outcomes.
"Deletion of chromosome 17p13, present in 10% of patients, confers poorer survival. Patients with this deletion who undergo HDT followed by autologous stem cell transplantation (ASCT) have significantly shorter progression-free and overall survival than patients without this deletion."
http://www.jnccn.org/content/8/Suppl_1/S-28.full
"The presence of baseline high-risk cytogenetics by FISH (hazard ratio 17.3; P = .002) and persistent minimal residual disease by multiparameter flow cytometry at day +100 after HDT/ASCT (hazard ratio 8.0; P = .005) were the only independent factors that predicted unsustained CR. Thus, these 2 parameters may help to identify patients in CR at risk of early progression after HDT/ASCT in whom novel treatments should be investigated."
http://www.ncbi.nlm.nih.gov/pubmed/22128143
http://bloodjournal.hematologylibrary.org/content/119/3/687.full
" All patients were conditioned with high-dose melphalan. With a median follow-up of 3.4 years, overall survival and event-free survival at 3 years were significantly worse in high-risk patients (48% vs. 97%; P = 0.0005 and 16% vs. 37%; P = 0.038, respectively) despite the higher CR plus VGPR rate among high-risk patients. In addition, survival at 1 year after progression was significantly worse in high-risk patients despite salvage chemotherapy containing thalidomide (32% vs. 100%, P = 0.0001). Combinations of cytogenetics and ISS could readily predict prognosis. Quality of response is a poor surrogate marker for ultimate outcome. High-risk patients may need more effective treatment"
http://www.ncbi.nlm.nih.gov/pubmed/19338045
http://myeloma.org/ArticlePage.action?articleId=3604
Sending you blessings,
suzierose
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
Re: Variance in M-Spike and Free Kappa Light Chains
Hi All, to get your stem cells harvested means that you have enough in liquid nitrogen storage for two stem cell transplants, should you need them. They can be stored by the hospital for up to five years. It amazed me that such a procedure even exists....stem cells are normally just in the marrow, but after the stimulation with neupogen, they multiply to the point where they burst out of your marrow into the circulating blood stream. When there are enough of them, and before they differentiate into functioning blood cells, they are harvested thru aphoresis. I could see a plastic bag full of orange stem cells slowly filling up during the day of harvesting. Then they were divided into smaller bags, and half brought out again a few weeks later for the transplant. Will never forget seeing the technician wearing huge protective gloves retrieving that bag from a vat of foggy liquid nitrogen!!
Maybe there are better alternatives to the use of cyclophosphamide, as Suzierose has researched. i wasn't a 'high risk' patient actually.
Maybe there are better alternatives to the use of cyclophosphamide, as Suzierose has researched. i wasn't a 'high risk' patient actually.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Variance in M-Spike and Free Kappa Light Chains
Hi, this is my first reply to The Myeloma Beacon although I´ve been visiting this site for more than a year. After the comment above from suzierose about the poor prognosis of highrisk multiple myeloma I just felt the need to mention a study published in Blood journal; " Administration of bortezomib before and after autologous stem-cell transplantation improves outcome in multiple myeloma patients with deletion 17p".
http://bloodjournal.hematologylibrary.org/content/early/2011/12/08/blood-2011-09-379164.abstract?sid=04c751f6-0c35-41c9-8abc-7052f6744300
This is great news for del17p patients as myself.
Keep fighting!
http://bloodjournal.hematologylibrary.org/content/early/2011/12/08/blood-2011-09-379164.abstract?sid=04c751f6-0c35-41c9-8abc-7052f6744300
This is great news for del17p patients as myself.
Keep fighting!
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asaryden - Name: asaryden
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: August 2010
- Age at diagnosis: 48
Re: Variance in M-Spike and Free Kappa Light Chains
Hi Assaryden!!
ICAM.
I too posted this great news here:
https://myelomabeacon.org/forum/high-risk-17p-good-news-with-bortezomib-t819.html
The big concern is the use of alkylators during harvesting and hi-dose chemo for SCT.
ICAM.
I too posted this great news here:
https://myelomabeacon.org/forum/high-risk-17p-good-news-with-bortezomib-t819.html
The big concern is the use of alkylators during harvesting and hi-dose chemo for SCT.
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
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