The Myeloma Beacon

Independent, up-to-date news and information for the multiple myeloma community.
Home page Deutsche Artikel Artículos Españoles

Forums

General questions and discussion about multiple myeloma (i.e., symptoms, lab results, news, etc.) If unsure where to post, use this discussion area.

Flc ratio

by Rex on Sat Sep 08, 2012 5:44 pm

Hi

I am new to the forum. My sister was diagnosed with smoldering myeloma 5 years ago, she still has no lesions but her igg is 5500, her mspike 3.8 and her flc ratio 1000 (kappa 43, lambda .03. Is this high--seems to be. And when does one start treatment? Her hemoglobin also runs around 10.5-11. Appreciate any input.

Rex

Re: Flc ratio

by terryl1 on Sat Sep 08, 2012 6:35 pm

Hi, I am sure a doctor will answer your questions specifically, but what were the results of the bone marrow biopsy? That would provide a lot of critical info. with regards to the level of plasma cell infiltration (i.e. over 10%). If you do not presently see a myeloma expert, I would advise you to do so. Make an appointment. now. This would ensure all necessary testing be done and you can make an educated decision about your treatment options. Good luck.

terryl1
Name: Terry
Who do you know with myeloma?: self
When were you/they diagnosed?: August 10, 2011
Age at diagnosis: 49

Re: Flc ratio

by Rex on Sat Sep 08, 2012 10:34 pm

Hi

I have had a bone marrow biopsy and it showed 30% plasma cells.

Rex

Re: Flc ratio

by terryl1 on Sun Sep 09, 2012 6:07 am

Hi Rex, I was diagnosed as having smoldering myeloma last year and I progressed to active myeloma in about eight months. I am currently in a special clinical trial at the NIH using carfilzomib. When I progressed, my FLC's exploded and the ratio went sky high. Yours does seem high as do your other numbers but what was the trend over the past five years and what does your present doctor say? Is he a myeloma expert or a general onc? There does seem to be anemia as well pursuant to the CRAB criteria. However, only a doctor can make sense of it all and I would strongly urge you to see a myeloma expert or two before you start any treatment as there are various treatment approaches and philosophies. It is not so cut and dried as in other diseases. In total, I saw three myeloma experts and each one had a different treatment plan. I chose the one which I thought was best for me. I wish you well.

terryl1
Name: Terry
Who do you know with myeloma?: self
When were you/they diagnosed?: August 10, 2011
Age at diagnosis: 49

Re: Flc ratio

by Dr. Peter Voorhees on Sun Sep 09, 2012 6:21 am

Dear Rex,

There is no specific M spike or light chain level at which you start treatment. If symptoms are starting to emerge (anemia, bone lesions or thinning of the bones, high serum calcium levels or kidney problems), treatment becomes necessary. Your sister is anemic to a modest extent. If the M spike and/or serum free kappa light chain level has been on the rise and the hemoglobin on the decline (and there is no other good explanation for the anemia), I would argue that it is time to think about treatment. Lastly, even if the myeloma can still be considered smoldering, it is considered high-risk based on the information you have provided (high M spike level, substantial marrow burden of disease, abnormal free light chain ratio). There are an increasing number of clinical trials being run for patients whose disease fits this profile to see if early intervention can alter the course of the disease. Data from a small trial out of Spain noted a benefit to the use of lenalidomide (Revlimid) and dexamethasone for patients with high risk smoldering myeloma. I agree with Terry1 about seeing someone who sees a lot of this to better determine the need to start treatment or not.

Let us know if you have any other questions. Good luck!

Pete V.
Dr. Peter Voorhees
University of North Carolina at Chapel Hill

Any advice provided in these postings is based on a very limited amount of information. There is no substitute for the care of your oncologist/hematologist. Therefore, all suggestions should be discussed with your treating physician. None of the comments presented here are meant to replace the evaluation of a patient by a knowledgeable physician.


Dr. Peter Voorhees
Name: Peter Voorhees, M.D.
Beacon Medical Advisor

Re: Flc ratio

by Rex on Sun Sep 09, 2012 9:17 am

Thank you for all of your input, I will share it with her. She lives in northern Michigan and sees just an oncologist, not hematologist, does that make a difference?

Also, in addition, she has been in the hospital 3 times in the past 2 years with infections. Twice with pneumonia and once with cellulitis. Does that change the picture as well?

Rex

Re: Flc ratio

by Dr. Peter Voorhees on Sun Sep 09, 2012 12:15 pm

Dear Rex,

It is always hard to be certain of things in this kind of venue but there are red flags here for possible symptomatic myeloma, with frequent infections being one such possible clue (anemia the other). I would suggest going down to U. Mich. or the Karmanos Cancer Center at Wayne State University (Dr. Zonder) to get another set of eyes to evaluate her circumstances.

Take care!

Pete V.
Dr. Peter Voorhees
University of North Carolina at Chapel Hill

Any advice provided in these postings is based on a very limited amount of information. There is no substitute for the care of your oncologist/hematologist. Therefore, all suggestions should be discussed with your treating physician. None of the comments presented here are meant to replace the evaluation of a patient by a knowledgeable physician.


Dr. Peter Voorhees
Name: Peter Voorhees, M.D.
Beacon Medical Advisor

Re: Flc ratio

by Chris M on Sun Sep 09, 2012 8:27 pm

Hi,
I would highly recommend contacting the Univ of Mich! We also live in northern Mich and while it's a long trek back and forth to U of M, with smoldering or full blown multiple myeloma you really want to go with specialists who treat multiple myeloma specifically.

My husband was diagnosed with multiple myeloma in May 2011, and at that time his M protein was 4.9 and it was in apprx 85% of his marrow. Many bone lesions, too. His local hematologist suggested seeing the multiple myeloma specialists at the Univ of Mich, which we did and he was enrolled in the carfilzomib/Revlimid/Dex trial for newly diagnosed patients. We live north of Gaylord and it takes about 3 1/2 hrs one way and despite the time spent on the road, we are so glad we went to the UM. He is in his 16th cycle now and although he has experienced many of the textbook complications from the multiple myeloma and medicines, he can still work part time and can do most of the things he used to and he's doing much better now. And while UM may seem far away, they have stayed in close contact with the local physicians when my husband has been up here in the local ER unexpectedly. Very good communication between the two hospitals.

The U of M Drs, PAs and RNs and aids have all been great and the Infusion nurses are SUPER special!

Chris M

Re: Flc ratio

by Rex on Sun Sep 09, 2012 9:36 pm

Thank you all, I will pass the information on to her.

Rex


Return to Multiple Myeloma