[Raj]

Why does bone marrow plasma go up after 2 cycles of chemo

by Raj on Fri Jul 03, 2015 6:30 am

Hello All,

My 47-year-old brother was diagnosed with multiple myeloma about 1 1/2 months back. His serum protein test was normal; the total protein in the blood was 8, which is within the limit, and no urine protein detected. However he had plasma levels of 28% from his bone marrow test, and he had one tumor in his rib.

He has now completed 2 cycles of chemotherapy with VTD (bortezomib - 2 mg). After this cycle, his bone marrow plasma cells show at 40%, however his pain symptom in his rib has gone away and he is not feeling any pain in the rib.

However, what could be reason for the increase of plasma? Does that mean that chemo is not working for him?

[Multibilly]

Re: Why does bone marrow plasma go up after 2 cycles of chem

by Multibilly on Fri Jul 03, 2015 8:45 am

Hi Raj,

Sorry to hear about your brother, but I'm glad his ribs are feeling better. I'm not a doctor, but I think that by itself would indicate that your brother is responding to the treatment.

When you say "his serum protein test was normal", are you referring to the results of the serum protein electrophoresis (SPEP) test that measures the serum monoclonal protein (this would be called the M-spike, monoclonal protein, paraprotein, abnormal protein, etc.). Or are you saying that the immunofixation (IFE) test detected no monoclonal proteins whatsoever?

I assume the doctor measured his serum kappa and lambda free light chains before and after the treatment? Were these values also normal before and after treatment?

The reason I am asking is it is somewhat unusual (less than 5% of patients) to have multiple myeloma with no serum M-spike and normal serum free light chain values. If the disease does only show up in the bone marrow plasma cells, this is known as nonsecretory multiple myeloma.

Having said this, it's always a challenge to track nonsecretory multiple myeloma with bone marrow biopsies since the disease isn't spread evenly throughout the body. It could be that the previous 28% plasma cell reading was based on an area of his bones where the disease was less concentrated.

Also, if your brother is nonsecretory, you can also use routine radiological imaging such as MRIs or PET/CTs to help monitor the progress the disease.

You can get a better idea of the challenges of monitoring nonsecretory multiple myeloma here:

http://www.cancernetwork.com/hematologic-malignancies/non-secretory-myeloma-one-two-or-more-entities

I know this doesn't quite answer your question, but it will be easier for folks to help you on this forum if they are clear just which version of multiple myeloma you are dealing with.

[Raj]

Re: Why does bone marrow plasma go up after 2 cycles of chem

by Raj on Fri Jul 03, 2015 1:31 pm

Thanks a lot for your reply. His SPEP did not measure any M-spike, also no M-band in the bone marrow biopsy. They measured free light kappa; it was 2980 and lambda was in the normal limit, which was 9.0. He did had a tumor in the rib and multiple lesions on the bones while PET scan was done in the beginning.

We are yet to get the result for free light kappa, which was done 2 days back along with the bone marrow test.

I wanted to understand whether it is possible that the plasma can still shoot up while chemo is taken and ongoing? Or is it that only test taken from different bone where it is not distributed evenly?

Please advise.

[Multibilly]

Re: Why does bone marrow plasma go up after 2 cycles of chem

by Multibilly on Fri Jul 03, 2015 5:19 pm

What are the units of measure for the free light chain values (different countries use different units of measure)?

Given that he had a significantly high free light chain ratio (kappa/lambda) of 331, your doc is probably going to look at how the serum free light chain values are responding to really determine how the chemo is going, and not just the plasma cell percentage. He is obviously secreting free light chains, so please ignore my comments about nonsecretory multiple myeloma.

In any case, it sounds like you will be getting yet another bone marrow plasma percentage reading very soon.

So, I would suggest not trying to second guess if his plasma cell percentage is really going up or if the chemo is working or not until you have the latest test results in and you have a chance to talk with the doctor...especially since his rib pain is improving!

[Raj]

Re: Why does bone marrow plasma go up after 2 cycles of chem

by Raj on Sat Jul 04, 2015 12:55 am

Thanks, Multibilly. I will get IgG report today, will check.