Hello Dr Indranil, I Have Consulted Before Many Times For

Question: Hello Dr Indranil,
I have consulted before many times for my mother (Age:71) who is a Multiple Myeloma Patient. She has been gone through radiation and chemotherapy after Kyphoplasty surgery in D9 vertebra (Done in 2011). She gave complete response to chemotherapy. After chemotherapy she has been on maintenance that included Lenalidomide 10 mg daily for 20 days and then 10 days gap before continuing further and also she's taking Zoldria injection after every 3 months.

A year back after observing her Kappa Lambda value and SPE value Dr. reduced medicine from 10 mg to 5 mg. Somewhere in between she had fever last year and had lot of weekness. At that time Dr. adviced to stop Lenalidomide till the time she felt alright. After that our Doctor told to continue with Lenalidomide. But she avoided to take as said by one of Junior doctor that "you are taking it since very long so its ok to stop it now". Since that time (10 months now) she did'nt consume Lenalidomide and we started monitoring FLC and SPE values monthly instead of 3 months. We observed drastic improvements in FLC values till last month. Where FLC vlaues were Kappa: 35.6 mg/L Lambda: 22.1 mg/L and Kappa Lambda Ratio: 1.61 i.e normal. But after one and a half month that is currently in July, when we repeated FLC test it showed High FLC Ratio i.e 5.23 and Kappa value 123 mg/L , Lambda:23.5 (Report attached). Reports of SPE KFT LFT and CBC are awaited. She is having light fever currently i.e. 99°F.

I am afraid to see this big jump in FLC ratio i.e.from 1.61 to 5.23 all of sudden in less than two months time. Although Kappa value had gone upto 117 mg/L last year and came down afterwards. But, Doctor please suggest if increase in ratio is indicator of anything serious here or it can be expected to increase this much with fever and pain in bones. What should be our next course of action here.

Thanks for your response.

I have just attached reports of tests LFT KFT CBC and Serum Protein Electrophoresis. M spike has appeared this time after very long time. It was not present till now after her Chemotherapy that was given in 2012. Since 2012 till last month M-spike was not present. But, this month all of a sudden it has appeared with value of 1.1 g/dl.

Please tell what stage of Myeloma it can be considered currently by looking at attached reports?

Hi Doctor,

I have uploaded the report again and also sent same on customer care email I'd.

Please suggest for next course of action. Since it's a relapse can the treatment still be that effective again if they'll give bortezomib like they gave initially.
Can treatment be started immediately, As I don't want any delay here, where report clearly indicates it's a relapse.

Thanks Doctor !

We've visited our Dr. and have shown him the reports. Dr. said that the reason of relapse was because my mother stopped taking Lenalidomide for 3 months i.e. from April - XXXXXXX 2019. Actually One of the junior doctor misguided us during that time for stopping the medicine as she is consuming from very long time and to reduce neuropathy problem.
Our Doctor was about to start Bortezomib therapy. But, after knowing this fact of taking break from Lenalidomide for 3 months, he dropped the plan of Brotezomib and then suggested to continue Lenalidomide 10 mg instead of 5 mg now for 21 days with one week gap. And to show up again after 6 weeks with CBC, KFT, LFT and FLC reports.
We have started giving her Lenalidomide 10 mg again now. But, as M-band has appeared again because of our mistake of pausing the medicine.

Please suggest what are the changes of M-band to be removed completely again with consumption of Lenalidomide?

Any other suggestion or guidance that you can give us at this point would be helpful.