This weeks’ ‘Ask Dr. Durie’ is actually
a pretty common question and concern which comes from a patient who is worried about
the fact that with one cycle of combination chemotherapy or therapy involving several
drugs that myeloma protein didn’t come down or just came down very very slightly. And so, this is a very common concern where
obviously we would be wanting to see the myeloma protein coming down right away with even one
round of treatment, and the protein would steadily be coming down wit
h each further
cycle. However, as you start treatment for myeloma,
it’s important to keep in mind that the protein level is going up rapidly, frequently
and so, as it turns out, stabilizing or staying at about the same level does frequently represent
an improvement. Because you see, without the treatment the
protein level would probably have continued to go up, maybe by one, two, three grams. And so, stabilizing can often be a very key
first step towards ongoing and further improvement. So, key
point: Do not panic. This is something which does happen, and it’s
not sufficient to say, “oh gosh, the treatment is not working.” The ongoing therapy, of course, we would be
expecting the myeloma protein to come down after that first cycle. And so, improvement in the second and third
cycles. And so, without panicking, if there were not
an improvement after two, three cycles in particular then we would want to review and
decide what is best. So, the BOTTOM LINE, very very important discuss
caref
ully the results of your myeloma protein levels and other tests, during that first
one, two, three cycles. And then, just decide together what is the
best strategy. One point to emphasize is that, if you get
a protein test result that comes back and it seems a little bit strange, maybe completely
out of line, well sometimes the lab can make a mistake. And so, it’s important to be ready to repeat
a test, if necessary, if it seems like a crazy result. But if you do have confirmation that numbers
a
re not coming down, that is, without panicking, a time to carefully sit down and review your
options and see what a best next step could be. With the good news being we do, fortunately,
have quite a number of options and chances are that there can be a good and safe and
effective alternate option.
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