Thursday, September 30, 2010

The marker number went up but does it mean anything?

Rebecca had a Freelite test on 21 Sep 2010. The Lambda free light chain protein increased from 18.1 mg/L to 30.9 mg/L. The normal range is 5.7 to 26.3 mg/L. The other interesting thing is the Kappa free light chain protein increased from 10.2 to 18.2 mg/L during this same time. The normal range for this is 3.3 to 19.4 mg/L.

Rebecca has both good plasma immune cells and plasma myeloma cells which are the cancer. The good plasma immune cells secrete both Kappa and Lambda light chain proteins in the process of making immunoglobulins to fight infections. Her myeloma cells secrete only the Lambda type proteins. This increase in Lambda proteins may not be an indication that her myeloma cells have increased in numbers. Since her Kappa proteins went up by the same ratio as her Lambda proteins this indicates the increase in the Lambda proteins came from her good immune cells and not the myeloma cells. She had a cold when the blood for this last test was drawn. Her Lambda protein count was at 1960 mg/L when she was diagnosed so a count of 31 is pretty insignificant. However, it is the increase that gets your attention. I assume an infection could cause the Lambda and Kappa proteins from your good immune cells to go above the normal range.

Rebecca is going to have a bone marrow biopsy tomorrow. She has only had two of these and it has been over a year. The purpose is to get the genetic testing done on the myeloma cell to see what type of DNA abnormalities there are. This can indicate the aggressiveness of the myeloma and supposedly help choose the type of treatment. They didn’t do the genetic testing on the first two biopsies and they should have.

Rebecca is still having the back pain we assume from the fractured vertebrae. Her digestive tract is still not working good and causing some discomfort and pain. The peripheral neuropathy has not improved any in her feet and left hand. She has increase her Lyrica another 50 mg twice a day to 150 mg twice a day. So far the Lyrica has not seemed to help. May have to keep increasing the dose some more to see if that will help. I do massage her feet a couple of times a day with Neuragen. That seems to give her a little relief.

Here are some of her lab results from 9/21/10:

WBC = 5.2 (4.8 - 10.8)
RBC = ?? (4.2 - 5.4)
HGB = 11.1 (12.0 - 16.0)
PLT = 128 (130 - 400)

IgG 473 mg/dl (700 - 1600
IgA 70 mg/dl (70 - 400)
IgM 12 mg/dl (40 - 230)
IEP - No monoclonal band identified.

Kappa Free Light Chains 18.2 mg/l (3.3 - 19.4)
Lambda Free Light Chains 30.9 mg/l (5.7 - 26.3)
Kappa/Lambda FLC ratio 0.59 (0.26 - 1.65)

Thursday, September 9, 2010

Not much from the visit to the pain clinic.

We saw our oncologist on August 12th. Went to a pain clinic the next day. Her pain medication was increased from 100 mg three times a day to 120 mg three times a day. Also got a prescription for Opana. The insurance company denied this so the Doctor has to file an appeal.

She took 8 mg of melphalan per day starting on the 17 of August for 4 days along with 40 mg of predisone each of the 4 days.  She has been doing this every 6 weeks now for about a year.
The peripheral neuropathy has not improved. This week she started taking 100 mg of Lyrica twice a day. The gut is still not working well.
We received some of the lab results from the blood draw of 8/12/2010.

WBC = 5.1 (4.8 - 10.8)
RBC = 3.45 (4.2 - 5.4)
HGB = 12.4 (12.0 - 16.0)
PLT = 139 (130 - 400)

IgG 485 mg/dl (700 - 1600
IgA 62 mg/dl (70 - 400)
IgM 14 mg/dl (40 - 230)
IEP - No monoclonal band identified.

Kappa Free Light Chains 10.2 mg/l (3.3 - 19.4)
Lambda Free Light Chains 18.1 mg/l (5.7 - 26.3)
Kappa/Lambda FLC ratio 1.77 (0.26 - 1.65)