This short post will definitely be primarily medical in nature. It required some research on my part so that I could attempt to explain the particular uniqueness of my Multiple Myeloma. I am dedicating this post to my dear friend, Lee Ann, whose questions inspire me to delve deeper into understanding the nuances of Multiple Myeloma, and in turn, share that understanding with you.
When people see me, they have no idea that I am battling cancer. I look to be the picture of health. I feel healthy, too, for the most part. Side effects of the treatment regimen present the biggest challenges for me. I also feel consternation over the 10 pounds I’ve gained since starting the Revlimid-Velcade-Dexamethasone chemotherapy and now the Darzalex-Velcade-Dexamethasone. The remedy, for me, is more activity, and I’m going to try to walk at least two miles every day, as I am able. I’ve been eating larger portions and cheating on my diet a lot too. Since the minor blip last week with the high calcium, I’ve been trying to increase my hydration as well, and that means more frequent trips to the bathroom, minor inconveniences, really.
During my appointment last Thursday with Dr. Joudeh, we discussed an aspect of my condition that I have been confused about. We always cover my lab results, and he noted how my numbers are consistently good. He was referring to my white and red blood counts, hemoglobin, neutrophils, sodium, glucose, etc. – all numbers within normal range, with the exception of my calcium, which he informed me about as soon as he had those results, and we took measures to correct. Actually, I was thinking of the IgA quantitative serum level and my kappa light chain numbers.
Dr. Joudeh invited me to pull the rolling stool closer to his computer so he could discuss these numbers and a familiar term that I had temporarily forgotten about.
“As you can see, you are doing very well with those results also.” He clicked on a screen that showed the numbers from the previous blood work, all well within normal levels for at least a few months now, indicating my response to the chemotherapy appeared to be good.
“I guess I’m trying to figure out when I might be ready for the transplant. If my numbers are good, what am I missing?” I asked.
“The M-protein,” he continued. “Yours is undetectable in your bloodstream because your myeloma is non-secretory.”
“It doesn’t secrete into my blood,” I said in response, confirming my understanding. He responded in the affirmative. “So, if we can’t measure it in my blood, is a bone marrow biopsy the only way to know what that percentage is?” I asked.
I’ll backtrack here for just a moment about this M-protein. It refers to the monoclonal protein, sometimes also called the myeloma protein or monoclonal immunoglobulin, M-spike, or paraprotein (2) that is excreted by the plasma produced in my bone marrow. My initial diagnosis, like many people with similar symptoms to mine, was Monoclonal Gammopathy of Undetermined Significance or MGUS. It was after the first bone marrow biopsy last November that we learned the significance of mine, and it will likely be another bone marrow biopsy that will tell us the percentage of abnormal protein, or M-protein, that’s still loitering around in my bone marrow. The target number Dr. Selby wants to see before I’m ready for the transplant is 5%.
While I don’t relish the thought of another bone marrow biopsy, the procedure is painless when done with light anesthesia. I am hoping the Darzalex-Velcade-Dexamethasone regimen is working, and I will soon be ready for a trip to The Stephenson Center at OU Health.
In my research, I found a case study of a 51-year-old woman whose diagnosis of Non-Secretory Multiple Myeloma (NSMM) is similar to mine, in case you'd like to read a little more about it.(3)
Reference
(1) “M-Protein Diagnostics of Multiple Myeloma Patients Treated with Biologics.” n.d. Www.youtube.com. Accessed April 8, 2021. https://www.youtube.com/watch?v=SngQEnMuoQc. (2) “What Is M Protein (Myeloma Protein)?” n.d. WebMD. Accessed April 6, 2021. https://www.webmd.com/cancer/multiple-myeloma/guide/m-protein-myeloma-protein-overview.
(3) Caldas, Ana Rita, Mariana Brandao, and Antonio Marinho. 2011. “Non-Secretory Myeloma or Light Chain-Producing Multiple Myeloma: A Case Report.” Journal of Medical Cases 2 (3): 97–100. https://www.journalmc.org/index.php/JMC/article/view/156/135#:~:text=Non-secretory%20multiple%20myeloma%20%28NSMM%29%20is%20a%20rare%20variant,not%20detectable%20monoclonal%20free%20light%20chain%20in%20urine%2Fserum.
Sending good thoughts and prayers your way. You are so amazing Kelly, you writing touches my heart. You know I’m just a phone call away. ❤️