My mother was diagnosed with Plasmacytoma after a pathological fracture last August, and was then given Velcade IV weekly till six weeks as her lambda kappa ratio kept on increasing. After 6 cycles of Velcade her B2 microglobulin was 3220 ng/ml so the doctor decided to give her 2 more rounds of Velcade every 15 days. Her blood test results after 8 cycles of Velcade are below,
Hb - 11.7
RBC - 4
ESR - 45
Platelets - 227000
WBC - 6400
B2 Microglobulin - 2780 ng/ml
lambda kappa ratio - 1.2
Now my question is that her Peripheral Smear Overview says that she has Anisocytosis and Polymorph Show mild left shift. Can anybody explain me what this Polymorph left shift suggests? Can that be as a result of Velcade side effect? Is it something to be concerned about?
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Re: What does Polymorph left shift suggest in Peripheral Sme
Left shifted polymononuclear cells simply indicates that the myeloid cells (a specific component of your white cells) are not completely maturing. It is not something to be overly concerned about and has very little to do with disease. It is more likely a reflection of some minor effects of Velcade. Velcade usually has its primary effects on lymphocytes. Is you mother on dexamethasone (steroids)? This may too cause the left shift.
It looks as though the rest of your mother's heme parameters look good and her SFLC ratio is normal.
Was she diagnosed with a solitary plasmacytoma or systemic disease? And did she get radiation for it? Typically, a solitary plasmacytoma is treated with radiation and with curative intent.
It looks as though the rest of your mother's heme parameters look good and her SFLC ratio is normal.
Was she diagnosed with a solitary plasmacytoma or systemic disease? And did she get radiation for it? Typically, a solitary plasmacytoma is treated with radiation and with curative intent.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: What does Polymorph left shift suggest in Peripheral Sme
Thank you so much Dr Shain for your quick reply. Yes my mother is on steroids but that is for 3 days after she is given Velcade IV. At the below URL I have added a history of my mother and also attached some reports so that you can have a better idea of her diagnosis.
https://myelomabeacon.org/forum/high-esr-and-b2-microglobulin-values-t1060.html
My mother was initially diagnosed with Non-secretary solitary plasmacytoma after a biopsy was done where she had a lesion which had caused pathological fracture. She was also given radiation at the site, and her bone marrow biopsy at that time did not any significant infiltration by the plasma cells. The only reason she was given Velcade was her ratio. As it kept on increasing and the doctor thought that if that was not treated it might damage her kidneys. Her B2 microglobulin value was also out of range 3220 ng/dl. After 8 cycles of Velcade which reduced to 2780ng/dl. Dr. can you please take a look at her history and reports at the above url and let me know what you think about it and if we are on the right track as far as treatment goes? Once again thank you so much for all this help and the time that you give us, its a tremendous help for us.
https://myelomabeacon.org/forum/high-esr-and-b2-microglobulin-values-t1060.html
My mother was initially diagnosed with Non-secretary solitary plasmacytoma after a biopsy was done where she had a lesion which had caused pathological fracture. She was also given radiation at the site, and her bone marrow biopsy at that time did not any significant infiltration by the plasma cells. The only reason she was given Velcade was her ratio. As it kept on increasing and the doctor thought that if that was not treated it might damage her kidneys. Her B2 microglobulin value was also out of range 3220 ng/dl. After 8 cycles of Velcade which reduced to 2780ng/dl. Dr. can you please take a look at her history and reports at the above url and let me know what you think about it and if we are on the right track as far as treatment goes? Once again thank you so much for all this help and the time that you give us, its a tremendous help for us.
Re: What does Polymorph left shift suggest in Peripheral Sme
I do recall this case. I am sorry that I did not see your summary last time.
She has received Rads, Thalidomide, and now 8 cycles of Velcade / dexamethasone with normalization of her SFLCs (ratio 1.3). I do not treat to normalize b2M. I also do not typically treat just an abormal ratio. I need other signs of systemic disease (hypercalcemia, renal (kidney) insufficiency, or bone disease - essentially, the "CRAB" symptoms) to direct care in this setting.
Hopefully she does not have any side effects from the Velcade, such as neurophathy. I would be willing to see how she does off therapy at this time ... if you have close follow-up. This would include imaging (skeletal surveys).
I believe the primary concern your doctor has is the presentation with fracture. He/she wants to avoid that in the future. Continuing Velcade therapy weekly 4/6 weeks per cycle or a complete cycle every 3 months are also reasonable options. All without dexamethasone.
The difficulty in this case is trying to define what she really had/has. An over-treated solitary plasmacytoma or multiple myeloma -systemic disease that required systemic treatment. Your mother has been treated like she has systemic disease. And trying to separate the two is not always straightforward.
She has received Rads, Thalidomide, and now 8 cycles of Velcade / dexamethasone with normalization of her SFLCs (ratio 1.3). I do not treat to normalize b2M. I also do not typically treat just an abormal ratio. I need other signs of systemic disease (hypercalcemia, renal (kidney) insufficiency, or bone disease - essentially, the "CRAB" symptoms) to direct care in this setting.
Hopefully she does not have any side effects from the Velcade, such as neurophathy. I would be willing to see how she does off therapy at this time ... if you have close follow-up. This would include imaging (skeletal surveys).
I believe the primary concern your doctor has is the presentation with fracture. He/she wants to avoid that in the future. Continuing Velcade therapy weekly 4/6 weeks per cycle or a complete cycle every 3 months are also reasonable options. All without dexamethasone.
The difficulty in this case is trying to define what she really had/has. An over-treated solitary plasmacytoma or multiple myeloma -systemic disease that required systemic treatment. Your mother has been treated like she has systemic disease. And trying to separate the two is not always straightforward.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: What does Polymorph left shift suggest in Peripheral Sme
So far she doesnt have any side effects from Velcade. And at present after her 8 cycles of Velcade she is on Thalidomide. Are there any drawbacks if her Doctor has over treated her plasmacytoma. From your reply it seems that you would not have treated her with anything with the test results that she is having even though her B2 Microglobulin value and ratio were high. Do you think that treating her with Velcade would have any negative impacts besides the side effects of the medication?
Also, her doctor has now suggested that after taking thalidomide for 20 days he will shift her to Lenalidomide(I think in US it is called Revlimid). Can you please explain me the difference between thalidomide and Lenalidomide? Do you think this is the correct course of treatment? Also Doctor, for how long can one take this drugs? I mean are there any prescribed limits that this drugs can be taken? My mother was on thalidomide before she was given Velcade and still her ratio kept on increasing. Is Velcade better than thalidomide?
I am really sorry for asking so many questions, but I have a lot of questions in my mind, and the only place I can rely on for finding answers is this forum.
Also, her doctor has now suggested that after taking thalidomide for 20 days he will shift her to Lenalidomide(I think in US it is called Revlimid). Can you please explain me the difference between thalidomide and Lenalidomide? Do you think this is the correct course of treatment? Also Doctor, for how long can one take this drugs? I mean are there any prescribed limits that this drugs can be taken? My mother was on thalidomide before she was given Velcade and still her ratio kept on increasing. Is Velcade better than thalidomide?
I am really sorry for asking so many questions, but I have a lot of questions in my mind, and the only place I can rely on for finding answers is this forum.
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