[wesley]

What testing to track my disease?

by wesley on Mon Nov 18, 2013 5:01 pm

Another question related to test results ... I was diagnosed in July of this year. Finished 3 courses of Revlimid-dexamethasone and am on my week off. Final course ends Dec 15.

I am FLC Lambda and thus my ratio is high, although I only have one value for FLC and that was just after diagnosis

My question is this: What kind of blood work should my local oncologist be doing to track my disease?

My IgA (I think you refer to it as "heavy", as it is not IgA FLC) has gone from 1800 at diagnosis to 1000 in Sept to 550 in Oct. I believe 300 is the top of the normal range. I think this is a pretty good response - not sure. My local onc seems happy with it.

And I have been getting CBC results each month (my liver enxymes are elevated, but all other CBC results are within normal range or very close (e.g. albumin, HGB)

My question is this: I'm getting no M protein values or Beta 2 Micro or M spike to track disease reduction. Just IgA. My local oncologist says that IgA is a "good enough proxy for disease tracking".

Is he right? Should I insist on M protein or other measures? How does IgA level correlate with the other measures.

I have my pre ASCT workup Jan 6 - 9 at Mayo Rochester. Scheduled to start Nupogen there Jan 31. I am sure that M spike will be part of the work up there.

Thanks

Wesley

[NStewart]

Re: What testing to track my disease?

by NStewart on Tue Nov 19, 2013 12:33 pm

Wesley-
I see my oncologist every 6 weeks and am on Rev 15 mg and Dex 20 mg. At each visit my doctor orders CBC, chem panel, SPEP, free lite test, TSH, and immunoglobulin panel. I think that's all. Some times other things are ordered, but I haven't paid attention to what they are and how often they are ordered. He pays particular attention to WBC, Hgb, platelets, creatinine, SPEP, free lite ratio, TSH and IgG levels. I am IgG kappa.

Is it necessary to do all of these tests each time I see him? I don't know, but the recommendation for Revlimid is to at least have the CBC and chem panel done every round of treatment. Obviously I don't have mine done every month, but my WBC and platelets are always within normal range. My Hgb tends to waiver in the 11.0 range which is low, but steady.

I hope this helps,
Nancy in Phila

[Dr. Jason Valent]

Re: What testing to track my disease?

by Dr. Jason Valent on Tue Nov 19, 2013 6:00 pm

We follow the IgA, M-protein, and free light chains (all disease assessment labs) every 4 weeks along with a CBC and chemistries. However the IgA levels are usually reliable and do serve as a marker of good response in your case.