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IgA Lambda // risks and issues to consider

by fitzmarek on Mon Aug 15, 2011 4:47 pm

Patient has IgA Lambda myeloma (high IgA and Lambda levels at diagnosis) with del17. His VRD induction and ASCT have achieved a complete response currently. He will likely pursue a Rev maintenance regimen.

Are there issues or risks to consider given patient's IgA Lambda form of the disease?

Thanks!

fitzmarek

Re: IgA Lambda // risks and issues to consider

by Dr. Ken Shain on Tue Aug 16, 2011 8:06 am

It is very good to hear that the patient is doing so well- acheiving CR. In the context of the therapies he has received, the most important risk feature is the deletion of chromosome 17. In the past, specifically prior to Velcade and Revlimid, non-IgG (IgA) myeloma were thought to not do as well. However, that is not as significant today. There a number of high risk features that we believe are overcome with contemporary therapy, unfortunately deletion 17 is not one of them. This is a group of patients that has benefitted the least from the progress we have made in myeloma to date.

I also agree with the decision for maintenance therapy after transplant, either with Revlimid or on a clinical trial, if available. The two large phase III studies (CALGB 100104 and IFM 2005-02) currently investigating maintenance therapy post transplant have both demonstrated a near doubling of progression free survival with Revlimid maintenance therapy . Importantly, a recent update of the CALGB study also demonstrated a statistically significant improvement in overall survival. For patients with high-risk disease (and/or residual disease after HDM-ASCT), I discuss the risks and benefits of maintenance therapy and recommend therapy.
Dr. Ken Shain
H. Lee Moffitt Cancer Center & Research Institute

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. Ken Shain
Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor

Re: IgA Lambda // risks and issues to consider

by fitzmarek on Wed Aug 17, 2011 2:57 pm

Thank you for the timely and comprehensive response.

fitzmarek


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