Myeloma Lessons: Taking the Plunge
Back in February, I wrote about a big decision that I would be facing in a couple of months – whether to go off treatment for the first time since my multiple myeloma diagnosis in June of 2013. It is now two months later, and it is decision time.
I have decided to “take the plunge” into the world of a drug holiday.
“Taking the plunge” may seem like an odd way to phrase it, since this should be a time for relief mixed with joy rather than a jump into the unknown. But with me, nothing about this disease has been clear or straightforward.
Usually treatment is stopped when the patient is clearly in remission. In my case, the best that we can say is that I may be in complete remission – or not.
To review, I was diagnosed with IgG lambda multiple myeloma and started down the road of Velcade (bortezomib), Revlimid (lenalidomide), and dexamethasone (VRD) induction therapy in July of 2013.
My M-spike came down rapidly, and in October the tests showed two M-spikes: 0.2 g/dL IgG kappa, and 0.1 g/dL IgG lambda. From that point on, the only M-spike that I had was IgG kappa. It was low prior to and after my stem cell transplant in January of 2014. But since that time, it has stair stepped up from the 0.1 g/dL through June of 2104 to the 0.3 to 0.4 g/dL level for about a year, and since then has hovered in the 1.0 to 1.2 g/dL region.
All during this time, there has been no evidence of relapse. No calcium, renal, or bone lesion activity, and my hemoglobin levels have been fine. So we have assumed that the M-spike is secondary monoclonal gammopathy of undetermined significance (secondary MGUS).
Hence, when I was approaching the two-year anniversary of Revlimid maintenance, my oncologist suggested that, assuming all remained the same, it would make sense to stop treatment “and see what happens.”
Not completely reassuring, but a seemingly sensible path to follow.
The blood test results immediately prior to the visit with my doctor two weeks ago were similar to what they had been, so I went into the appointment with the decision made to stop treatment.
My doctor came in to the room and pulled up my test results. He furrowed his brow at the increase in my IgG levels. Admittedly, the level was slightly above the top of the normal range, but not alarmingly so, and not above what it had been at various other times during the past year. He turned to me and said,“Well, we can just continue the Revlimid at the current dosage.”
This caught me completely by surprise. I replied, “Are you waffling on me?!” I reminded him that we had agreed to stop treatment if the relevant numbers remained the same. He responded, “I am 99 percent sure that you have secondary MGUS, but …” He left the thought unfinished.
This exchange did not help my frame of mind. I wrote off his ambivalence as just a doctor being overly cautious, perhaps protecting himself against responsibility for a bad result. I don’t mean to sound harsh, but being an attorney, I recognize that doctors have been influenced by the risk of malpractice litigation – especially when their patient is a lawyer. I don’t begrudge this approach, and really my doctor is wonderful guy. I just take it into consideration when deciding what to do.
This whole secondary MGUS thing is baffling. There are many studies discussing the phenomenon, but no consensus on why it occurs. It seems to have positive prognostic value – or at least does not represent a relapse – but no one knows why that is. The studies are not detailed enough to reveal whether it is common or rare for the benign M-spike to increase as mine has over the period of two and a half years. And my level is relatively high for secondary MGUS, although apparently not unprecedented.
While secondary MGUS may indeed be a good thing, I would just as soon settle for a boring old zero in the M-spike column.
With all of this as background, my thought process goes something like this:
- I may be in complete remission.
- If I am in complete remission, it seems to be silly, unnecessary, and potentially harmful to continue treatment with powerful drugs.
- I have no symptoms that appear to require intervention at this time.
- If the M-spike that I see in my results is not secondary MGUS, then the disease will declare itself soon enough.
- If the multiple myeloma starts to progress, it is unlikely to proceed quickly, leaving ample time to restart treatment to knock it back down.
So taking all of this into consideration, I have decided to take the plunge and stop taking Revlimid.
This should be a time to rejoice. After all, who wouldn’t want to be relieved of the inconveniences and side effects of treatment?
But there is this nagging doubt despite the logic behind stopping.
Cliff diving is a popular adventure sport, especially in vacation destinations – maybe the most well-known being Acapulco. It is exhilarating, at least in part because no matter what precautions you take, there is always the element of the unknown. Maybe there is rock down there that no one has seen before, or the waves might not behave properly, leaving too little water in which to land. This element of risk is what makes the dive so popular among thrill seekers.
When it comes to treating a serious disease like multiple myeloma, thrill seeking is not the objective. But I find myself, nevertheless, deciding to take the plunge off the cliff into the non-treatment pool – not for thrills, but for the prospect that my life will be better being treatment-free.
I will gladly settle for a thrill-free float down the river of remission.
Andrew Gordon is a multiple myeloma patient and columnist at The Myeloma Beacon. You can view a list of his previously published columns here.
If you are interested in writing a regular column for The Myeloma Beacon, please contact the Beacon team at .
Well done Andrew.
You are currently in a similar situation as me. I'm in remission for the past 5 years and hope to continue in that state for as long as I can. This however demands doing everything possible to get and keep the immune system working to its maximum as I have adapted a "zero tolerance" attitude to myeloma.
So far, this approach is working well for me, vitamin D and vitamin B12 are the main requirements, plus occasional zinc and kelp, etc., supplements.
Best wishes,
Mervyn
Kudos on your carefully considered decision, Andrew. And thanks all the more for sharing with us regularly your thoughts and experiences related to these sorts of issues.
Any myeloma specialist worth his or her salt will admit several things when it comes to maintenance therapy for multiple myeloma.
First, that the preponderance of evidence suggests maintenance therapy improves progression-free survival, but not OVERALL survival.
Second, that the one major clinical trial that has shown an overall survival benefit for maintenance therapy is a horribly designed trial.
Third, that maintenance therapy often -- if not typically -- has a negative impact on the quality of life myeloma patients.
So you should be at peace with your decision. True, you will probably relapse earlier than if you had continued your maintenance therapy. But you'll also be more likely at relapse to respond, and respond longer, to retreatment with Revlimid, than if you continued on maintenance.
You also have a lower chance of developing a second cancer, such as MDS or AML, now that you have stopped maintenance.
So your overall survival is not likely to be affected by your decision. And your quality of life will probably be better.
Good luck!
Nice job on the article (and the decision to take a drug holiday). As you know, I wrestle with this decision every day. My biggest concern is "will we catch it again before it does serious harm?" and "how bad will those side effects be when we restart treatment?" Back to you. What marker (or markers) will you use to determine when to restart treatment, other than the obvious CRAB features?
Thanks for all your help,
Don Hoke
Good luck, Andrew, with the 'drug free' time. I was off chemotherapy for three and a half years, and that was really helpful to me. At first, there was no detectable 'M' spike, but after about 2 1/2 years, the monoclonal protein reappeared on the SPEP tests, and eventually got to a point where I needed treatments again. But the treatments have been successful so far, and I don't mind taking the Revlimid / dex again.
Although I'm jealous that you are stopping your chemotherapy, I have to worry myself that if it comes back, will the chemo knock it down again?
I've been on Revlimid for over nine years now. I chose not to have the transplant and just go with chemo. Took a year to get my M-spike down to zero at 25 mg. I now hover at 0.1 on 15 mg, but like I said, I'm chicken to stop it.
My oncologist has actually never even suggested it. I guess because her theory seems to be don't fix what ain't broken. Lol
I do wish you a lot of luck and will look forward to your future articles to see how you're doing.
"Drug free" "Drug free" Those words are so beautiful. One of the greatest of gifts.
I think it's good to let your body get a break from the drugs, if you can. And, like Terry says, maintenance does not really change the overall survival rate. I've had 2 breaks from Revlimid when I was on it, and though both were only around 10 months, it was great to feel 'normal'. Also, just get your monthly labs done and you will know what's changing or not. I wouldn't, personally, go more than a month without labs. I'm just about finished with my course of Velcade, and it's most likely I will not do maintenance but will keep up on labs so when my numbers start to change, we will know it's time to get back on the drugs.
I am thrilled and terrified for you all at once, your situation and story are so much like my husbands. I fear him going off medication, that safety net that keeps his numbers low, that safety net that keeps him here with me. I will be praying for you and keeping a watchful eye on your future articles. Good Luck and God Bless!
Andrew,
Many of us can relate all to well to your quandry! Actually, in the larger scheme of things in myeloma world we know ourselves to be lucky to be in this situation. So, let's be thankful for being in this position, which I am sure you are, as am I!
I was diagnosed in April, 2014 with kappa light chain, did about 5-6 induction cycles with RVD, which gave me "almost" a CR. (Still had monoclonal IGA showing on my electrophoresis, but no m-spike and normal light chains and ratio, PET/CT and BMB) After SCT in October, 2014, everything normalized and I had an sCR, which has remained as such since my last labs on March 25th. I did have oligoclonal banding which appeared around December, 2014, and persisted until August,2015. Obviously, it was a different clone or clones from the IGa Kappa at initial presentation. It was IGG kappa and/or lambda, variably, but last few months remained IGG kappa. This has since disappeared.
In March, 2015, I began maintenance therapy -- velcade injection, bi-weekly with 12 mgs of dex, (IV), and 5 mgs of Revlimid on a 21 day cycle. I was prescribed this regimen due to chromosome 1 addition at diagnosis. I had had a hard time with the Revlimid at 10 mgs during my induction, and this persisted even at the 5 mg level during maintenance. It was mostly GI in nature. The problem was that it was constipation and/or diarrhea, so it was difficult to control, because I never knew which way to treat it, although I did try various things that made it a little better. However, it was never easy to get right, and I always had to be cognizant of what I was eating, how long I had to be away from a bathroom, loss of appetite and general gi problems. Then in September, 2015, I began to have really severe muscle pain and cramping. My legs, my chest, my hands and feet...pretty much all over. The muscle pain was so bad in my chest, I finally went to the ER, where they ruled out a heart attack. My CPK (muscle inflammation marker) was elevated to 1500, (normal is up to about 150). At this point, although my oncologist "doubted" is was the drugs, (really?), gave me a drug holiday....off ALL drugs. All along I contended that the Revlimid was the culprit, btw.
My doctor decided to keep me off all drugs, and,ultimately, just to watch my labs very closely, (biweekly). It made me nervous to be off all drugs, as my research told me that maintenance is highly recommended for people who have chromosome 1 addition, but really, for most patients, as it portends greater PFS, if not OS. So after a couple of months, I met with my doctor and told him that I wanted to continue with the velcade and dex. Incidentally, it was recommended by the myeloma specialist I see occasionally that I be on maintenance for 3 years, minimum, depending upon whether I remain in sCR. If I didn't, obviously, there would be a treatment change.
The upshot to this long story, (I apologize - I do go on!!!), is that I remain on the velcade and dex combo bi-weekly, and so far with good results -- I think....(who really knows whether or not I would be in the same position without maintenance?) Small downside is having to go to the doctor's office twice per month....not a big deal to me. I also get full labs done every two weeks which makes me feel secure that I am being watched as closely as possible for any changes. Of course, this can drive one a bit crazy too, scouring the blood work, (which invariably has small changes, both myeloma related and not.....what does this or that mean, if anything -- the myeloma follies!)
When we were deciding whether or not continue maintenance after my muscle inflammation issue resolved, one of the things that was recommended by the myeloma specialist was for me to undergo another BMB to confirm that I was, indeed, still in sCR. I elected not to do that, but I thought it was a fair point. (I'm a wuss!) The myeloma specialist said that if my BMB was normal, (as it had been both before and after my SCT), it would be "appropriate" for me to go off all maintenance. Did you catch that word, "appropriate?" I read that to be "not optimal but acceptable." Maybe I am mincing words here, but that was my interpretation.
Andrew, I know that you had problems with your first bone marrow at diagnosis, in that it was a dry tap, if I remember correctly. But perhaps if you had one now it would produce some data that would give your decision some weight? Just a thought. That's the only test you have not repeated, no? I know it is unpleasant, but perhaps you can have it under general sedation.
Not only was I concerned about the immediate Revlimid side effects I was experiencing, but I was also concerned about the long term possibility of developing a secondary cancer. So, as of right now, I am comfortable with my decision. My quality of life, although not as good as it was before I became ill, is pretty good. I can do mostly everything I want to do. Some dex side effects, maybe a little fatigue and loss of appetite from the Velcade (malaise for a day or two here and there), but nothing I cannot deal with. Much better without the Revlimid. No more muscle cramps and pain, so I am able to exercise again ... yeah!
So sorry for this long post. Takeaway? Maybe the BMB for peace of mind, if you can stand it. And, for the rest of us, maybe question your maintenance recommendations, and go to a myeloma specialist to corroborate the decision.
Once again, sorry for the long post! Have a great day everyone, and remember, you are in charge of your treatment. Never be afraid to question your doctor, seek another opinion, stay educated and read the Beacon – an invaluable source of information!
Andrew,
Thanks for a thoughtful article about a difficult decision. I wish you a "thrill-free float" down that river.
My wife's situation is somewhat like yours. She was diagnosed in September 2012, had RVd induction and an autologous stem cell transplant (ASCT), and has been on aggressive treatment ever since due to high-risk cytogenetics. Her M-spike has remained between 0.4 and 0.95 g/dL; it has never gone lower, but it has never shown rapid increase. The idea of secondary MGUS has not been considered, in spite of consultations with several myeloma experts.
I have a couple of technical questions.
You said that your post-induction tests "showed two M-spikes: 0.2 g/dL IgG kappa, and 0.1 g/dL IgG lambda." Exactly what test was used to get these results? Usually SPEP reveals only one spike, and it does not give the isotype. Even if two spikes appear, the isotypes are not determined. To find the isotypes, immunofixation electrophoresis is usually used, but it does not produce quantitative measures. Was the new Hevylite assay involved? It shows the amount of each heavy-light isotype in the serum, but this is the total concentration of the immunoglobulin molecules of that type; many of them made by normal and healthy plasma cells, and the test does not show how many were made by the cancerous plasma cells.
You later said that the elevated IgG level in your latest test caused your doctor to re-consider the drug holiday. However, the quantitative immunoglobulin tests (where IgG, IgA, and IgM levels are usually measured in myeloma patients) are not a reliable way to monitor the disease. That's because only *some* of the amount measured is due to the myeloma, and the rest is from normal plasma cells. The normal immunoglobulin levels can vary for many reasons. It it therefore much more reliable to look at the monoclonal protein level (M spike) from SPEP, and/or the serum free light chain levels. You did not say what those showed in your latest tests. So why was the IgG level considered the more important indicator?
Finally, one comment: Myeloma patients often talk about "remission," but that word is rarely used by myeloma experts, and it is hardly ever seen in published papers on myeloma. That's because, unlike in some other cancers, it is not well defined for myeloma. When the M spike is "zero" (too low to measure) and some other criteria are met, that's called CR, but R stands for "response" not "remission". The best we can do is "MRD negative," but the MRD (minimum residual disease) tests are not yet widely available, and the current ones require a bone marrow sample.
Best wishes,
Larry
Andrew - A great column (as usual), about an issue that probably every myeloma patient has given much thought to. As I move into a third year of a Revlimid regimen, going drug free is certainly something I think about often. I respect how you analytically broke down your decision making process for us and it is one we can all learn from. I can't wait to hear in future columns how being drug free impacts your quality of life.
I'm sorry for the challenges your wife has faced since her diagnosis, Larry. However, I have to correct a few things in your comment.
First of all, this statement:
"Myeloma patients often talk about 'remission,' but that word is rarely used by myeloma experts, and it is hardly ever seen in published papers on myeloma."
is just not true. Myeloma specialists routinely use "remission" as a synonym for "response", both in casual conversation and in published papers. I can find countless examples online, but here are just a few from published papers, written by leading myeloma experts, and many of them published in the past year:
International panel of myeloma experts: http://www.ncbi.nlm.nih.gov/pubmed/26428082
T Facon: http://www.ncbi.nlm.nih.gov/pubmed/26637734
S Lonial: http://www.ncbi.nlm.nih.gov/pubmed/26841009
BG Durie: http://www.ncbi.nlm.nih.gov/pubmed/16354323 ("durable remission" is part of title)
Second, any good myeloma specialist will consider the totality of evidence when assessing the current state of a patient's disease, not just one or two tests. This means, for example, that a good specialist will look at the total IgG level in a patient with IgG multiple myeloma, knowing full well that the total IgG level is the sum of the healthy IgG level and the monoclonal (myeloma) IgG level. Looking at that level is just part of the triangulation process, and if the IgG level is noticeably off in comparison to other metrics, it might cause some pause on the part of the specialist, as it is always possible for tests to be off.
Hello, Andrew!
Thanks so much for your article and telling about your thinking regarding continuing maintenance. This is such an important thing to know about, especially as I continue on my own maintenance of Velcade every other week with the hope that I continue in remission. I really appreciated, too, the in-depth responses to your column - it generated a lot of thinking and comment. My very best to you on your "holiday."
Larry,
Andrew and I use the same oncologist and labs, and our reports state Serum Immunofixation Interpretation stating Serum Immunotyping Interpretation electrophoresis identifies the type IgG (kappa or lambda) and estimates it to be 500 mg/dl (or whatever number), and the Freelite test determines the free light chain numbers (if that makes any sense to you).
Don Hoke
Lots of great comments. I appreciate the kind wishes from so many. Let me dig into some of the points raised and questions.
Terry H. – Good summary of the research and some of the considerations that I took into account. As you suggest, I am hoping for a quality of improvement, but that is such a wildcard for me. I actually have felt pretty good for the past year plus. We shall see if there is improvement.
Don – I certainly share your concerns. I just have to do the research and proceed in the way the feels best to me. As for what "markers" I will be looking for in deciding when to re-start treatment, I am not really sure. My doctor said he would recommend treatment be re-started if the supposedly secondary M-spike reaches 1.4 g/dl, since that represents a 25% increase from where it is now. That seems a bit arbitrary to me. Another myeloma specialist who has seen some of my numbers has suggested that he would not re-start treatment until the M-spike reached 3.0 g/dl. In the end, I think when I become concerned I will seek out at least one more opinion.
Richard – Nine years on Revlimid! Wow, that's quite a ride. I completely understand the "don't mess with success" approach. If there were not countervailing concerns with long-term Revlimid use, I would have been more inclined to continue. I am not as concerned with the risk that it won't be effective if re-started, since that does not appear to be a serious risk, and there are other options if the Revlimid is not effective.
Christina – Nice to hear about your experience. You can be sure that I will be getting monthly blood tests!
Roberta – Your reaction is the same as my fiancee's. She is scared that I am going off treatment. I appreciate your prayers.
Ellen – You are correct that I had a difficult, dry-tap bone marrow biopsy the first time I had one. But I have had two since then, the last six months ago, and they were clean. We discussed doing another one at my last oncologist appointment, but decided to put it off for a bit.
Larry – Terry and Don beat me to it and answered your questions. Our test shows the isotype and the level. The IgG was a small concern at this time but, in the end, just something to keep an eye on since there can be many reasons for a small elevation above normal.
Drug free is wonderful. You will still have checkups every 3 months or so right? I did this for about 1.5 years before the M protein started to make a comeback. The drug-free period was grrreat. Congrats
Hi Andrew - Great column and responses! Been there, done that, with the medication break quandary. It's a tough one to be sure. Briefly, I was diagnosed IgA December 2009, did 10 mg Revlimid + 40 mg dex for 5 months, then Cytoxan IV in prep for July 2010 auto SCT with melphalan. Did fine, declared full remission, then put on low dose 5 mg Revlimid for about 18 months.
My doctors wanted to see how things would go with a medication holiday, so we did a break from mid 2012 to mid 2013 ... and guess what happened during my med break /drug holiday? Yep, hello myeloma ... it's baaaack! Started back on Revlimid + dex again, moving from 5 mg to 10 mg to alternating 10 mg and 15 mg. Well, my numbers slowly crept back up over 2 years, and this past Nov 2015, I made the switch to Kyprolis + dex and my numbers dropped dramatically.
So, not to offend, but my "personal opinion" is I will "never" not be on some sort of treatment. For me and my "type of myeloma", I see multiple myeloma as chronic, and I accept this, and feel much more comfortable treating it, then waiting for it to rear it's ugly head. And just a side note to all of this, I also believe in "less is more", and always request the lowest dose to see how that goes, hence preserving the health of my vital organs. So I'm steady meds, but not super aggressive, and I am happy to report "no detectable M Protein, and my IgA has dropped from almost 1900 to 530 in just a few months! I'll celebrate my 6 year SCT anniversary in July, and overall I'm pretty functional lol.
Best of luck Andrew, and I sure hope your medication holiday works out for you, and lasts a looooooong time!
Eric – For now I am on an every two months appointment schedule with labs every four weeks.
Julie – Thanks for relating your treatment history. Your approach of starting out with the smallest dose is certainly worth considering, especially since it seems like the docs start with the highest recommended dose and reduce if side effects are difficult. If I may ask, what are the dosages for your current Kyprolis / dex regimen, and how are the side effects?
What a thoughtful, insightful column about a decision that many of us have faced or are facing or will face. I did some lengthy drug-free holidays early on in my myeloma trek, and look back with nostalgia on those days. My oncologist did quarterly monitoring of my labs and I went back on meds (Velcade initially) when we could no longer ignore the fact that I was relapsing.
May you have a good, long break.
I'm about the same as Richard. I had a CR after 4 cycles of induction therapy (VTD), no SCT, and have been on Revlimid maintenance for over 7 years. There has been no mention of a therapy holiday, as both my oncologist and sister (who is a breast cancer radiologist) are concerned that a holiday will allow the cancer to come back, mutate into something more aggressive, and/or become unresponsive to the same therapy. However, there are lots of trials going on, and we do have options. I realize there are risks involved with remaining on the "poison"; however, the risks are less to me than letting the cancer live inside me and do what it wants. I am also tested regularly, so my medical team is always watching for any telltale signs of secondary disease. We are all different and respond differently, and I know of people who have done very well going off treatment. I applaud you for making this very difficult decision and wish you all the best.
Andrew - Rest your fevered brow, and enjoy the he-- out of your Holiday. May it be a real long one, too!
Regards.
Hi Andrew, thank you for replying and being interested in my situation. I had my Kyprolis (carfilzomib) infusion today along with my "BFF" dex, so here I am all buzzed up and reading late at night LoL
Ok, I asked my oncology pharmacist what dose I am on for Kyprolis. (It was so much "easier" knowing pill form doses on Revlimid!) He said they dose based on "body mass index," or words to that effect. I was buzzing from dex, so my memory fails me. I'm somewhat "petite" so my dose is lower to begin with, but I requested from the outset to go with the lowest, successful option. Per standard protocol, they start the first month of Kyprolis lower, and increase from there to toleration (Kyprolis U.S. prescribing information)
They assure me at each infusion that I am still much lower than the "standard dosing". My myeloma markers tell a great story with this option. We're happy with the results from just November 2015 to now, Apr 2016.
Ok, I checked my treatment "receipts" and here's the stats:
November 2015 = Carfilzomib IVPB 23.7 mg (KYPROLIS) for 6 infusions.
With 20 mg dex, which I take as 10 mg at home prior to infusion, 2x per week (Monday, Tuesday).
December 2015 to Present = Carfilzomib IVPB 31.6 mg (KYPROLIS)
No change in the dex 20 mg: 10 mg + 10 mg
I have remained on this protocol to date.
From my infusion receipt, here's my weight stats, so you can get an idea of the dosing calculations:
Body Mass Index 24.16 kg/m2, Body Surface Area 1.58 m2
I'm no mathematician, so I don't fully get all this, but thrilled to report it's all sending myeloma packing!
My doctor wanted to try Kyprolis alone without the dex, since I have been on it for so long, as she was worried about permanent side effects. Well that was a short lived experiment, as my M Protein and IgA shot back up without our dear friend dex. So I am back on that, and that's fine with me.
So, to sum it all up, Kyprolis and dex is working wonders for me. Last labs showed no measurable M Protein, and my IgA is nearing the high end of normal. Thrilling to me, considering at diagnosis in December 2009, my IgA was 5700 (high end of normal = 400), and my M protein was 4.3!
Hopes this helps you with your BIG DECISION, Andrew. Best of luck, and enjoy your treatment holiday, if you decide that route.
Hi Andrew,
Great column! Just an aside question. Are you talking Zometa and, if so, will you stop that also?
Best regards,
Patty
Patty – I have been off bisphosphonates – in my case Aredia (pamidronate) – for a while now because of a so far minor case of osteonecrosis of the jaw (ONJ). I wrote about this in my column last May.
Hello Andrew, Once again a well written article on what we as myeloma patients think about often, when or if to take a break from drugs.
I am a great advocate of drug holidays, and after 6 years on this myeloma journey, those holidays keep me engaged in life. Unfortunately, Revlimid works well but is not a friend of my body.
Sometimes, I think of time away from drugs not as "taking the plunge", but a graceful dive to try a different stroke. Take care,
Maureen
Andrew,
Kudos on a well written article. I made that same decision shortly after six months of RVD, radiation, followed by an autologous transplant. Even though my numbers where not ideal, my immunoglobulins results above normal,
IgG 2192 mg/dL 700-1600 mg/dL
IgA <50 mg/dL 70-400 mg/dL
IgM <25 mg/dL 40-230 mg/dL
Kappa Quant Free Light Chains 82.34 mg/L 3.30-19.40 mg/L
Lambda Quant Free Light Chains 4.05 mg/L 5.71-26.30 mg/L
Kappa/Lambda Quan Free Light Chain Ratio 20.33 0.26-1.62
Add to that other factors, I chose to go naked. I watch what I eat and exercise as much as I can. Always in the back of mind, is this an exercise pain or a myeloma pain.
As my private oncologist said, one can die from the treatment as well as the disease. Unfortunately, you have to choose your poison.
John
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