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MRI Revealed Compression Fracture, Possible Maglinancy, PET Scan Showed FNAC, Followed By Radiation Therapy. Possibility?

Posted on Fri, 15 Jun 2012

Question: I am from India.This is regarding a patient (my mother). She got severe pain in back on XXXXXXX 23rd. Doctor suggested for MRI scan, which revealed compression fracture in D9 vertebrae. And report also indicated possibility of maglinancy. Further doctor adviced for PET scan which was followed by FNAC (biopsy of D9 vertebrae). The report indicated matastatic carcinoma with primary in kidney, while in PET CT SCAN both the kidneys reflected normal. 24 Hrs Bence XXXXXXX protiens was also negative, whereas serum electrophoresis shows Mspike 1.17 gm/dl in beta region. She was then admitted to AIIMS hospital (after 4 weeks of initial pain) for Kyphoplasty of D9 vertebrae. At the time of kyphoplasty biopsy was also done. Kyphoplasty relived her from pain 75%. And the report of Biopsy from D9 vertebrae did'nt show any maglinancy, where as serum electrophoresis now show 1.5 g/dl Mspike in fast gamma region. Beta 2 microglobulin report shows 3.8 ug/ml. Bone marrow Aspiration shows 4% plasma cells. Free light chain essay shows Free kappa 53.77 mg/L (H) Free lambda 17.62 mg/L. After that we followed for Radiation therapy of D9 vertebrae in Medanta Hospital. Which was given 44 gray in 22 fractions. Further doctor adviced to wait for 6 weeks after radiation, before any test may be performed. Serum Electrophoresis report (after 6 weeks of radiation) shows M spike 1.55 g/dl. 24 Hrs bence jone was negative. In skeletal survey no lesion found except cemented D9 vertebrae collapse body. Free light chain was then adviced which show Kappa light chain 75.04 mg/L (High) and Lambda 26.31 mg/L ( almost normal) FLC kappa/lambda ratio 2.8. After 2 months of radiation therapy again serum electrophoresis was done which is now 1.66 g/dl and beta 2 microglobulin is 2066.6 ug/L (normal range: 671-1310). LDH is 180 (normal < 247). Just few days ago a Bone marrow biopsy with aspiration shows 7% plasma cells increased as compaired to last bone marrow. Please advice urgently. The value of Mspike and plasma cells in bone marrow are increasing on every performed test even after radiation therapy.

Answered by Dr. Indranil Ghosh (21 hours later)

Hello,

Thanks for writing to me.

I have gone through all the reports. I agree with the diagnosis that she probably had a solitary plasmocytoma (though it was not biopsy proven). The reasons behind this conclusion are, PET-CT and skeletal survey showing no other lesions, abnormal kappa/lambda ratio, elevated M-spike, BM plasma cells % normal. I assume normal calcium, hemoglobin and creatinine levels.

Regarding the condition now, I see that the FLC ratio and M spike levels have remained stable (small variation noted is acceptable). BM plasma cells % has slightly increased but that is still within normal limit. In addition the multiple myeloma. This will require regular testing. If in the event she has a progression, then systemic therapy will be required. Therapy for myeloma has advanced a lot in recent years and good results may be expected.

As of now, she needs only follow-up.

Hope I have answered your query. Please accept my answer in case you do not have further queries.

Regards,

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Indranil Ghosh (2 hours later)

Dear Doctor,
After been through information on internet, I observed that multiple myeloma is not curable. Therefore, would like to ask that what can be done now as a precautionary measure so that desease may not progress to MM.
She already had got a zoledronic acid injection as suggested by doctor. And will take once in every month, but doctor said that it's for bones. It has nothing to do with progression of main disease (Mspike and plasma cell levels in bone marrow).
Kindly let me know for any precaution (including diet) or any other medicine which can be taken to stop the progression.
Thanks for your help XXXXXXX XXXXXXX

Answered by Dr. Indranil Ghosh (3 hours later)

Hello.

Thanks for writing again.

Unfortunately, there is no precautionary measure to prevent progression of Plasmacytoma to Multiple myeloma. You said rightly that Zoledronate is only for the bones.

We have to monitor her regularly and initiate prompt treatment as soon as required.

As I said earlier, there are many novel treatment options for Multiple myeloma and results are promisisng. But again, the disease stands incurable as of now.

Hope this helps to answer your query. Please accept my answer in case you do not have further queries.

Regards.

Above answer was peer-reviewed by : Dr. Jyoti Patil

Follow up: Dr. Indranil Ghosh (20 hours later)

Thanks doctor for all your advice.I'll get her keep monitored by doctors as for now as suggested. But, Just a last question I would like to ask that in case the disease progresses, then will she be applicable for stem cell transplant as far as her age (63 yrs) and this desease is concerned. She is health wise good and does not have any complications.

Thanks & Regards
XXXXXXX

Answered by Dr. Indranil Ghosh (1 hour later)

Hello.

Thanks for follow up.

Age itself is not a bar for stem cell transplant and age of 63 years is certainly not a contraindication for transplant. As she is in good health with no co-morbidities and normal organ function, she certainly seems to be a candidate for stem cell transplant if required.

But we need to keep in mind that if she requires it after 5 years, she may not be suitable at that point of time. However, that does not influence the treatment strategy at this point.

Hope, this answers your query. Please accept my answer in case you do not have further queries.

Regards.

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Jyoti Patil