In this new episode of #AskDrDurie, IMF Chairman Dr. Brian Durie discusses how fast a myeloma patient would see improvement in both Freelite and protein levels with treatment such as three-drug combinations.
DR DURIE: This week’s #AskDrDurie is about a topic, which is very frequently asked to me. Many patients are anxious to know, ‘What is the pattern of response if one is tracking the Freelite and the total protein level in the blood?’ And patients quite naturally want to know if they are taking treatment, and it’s working well, what would be the typical speed of improvement in the Freelite level and the total protein level? And so, I’m very pleased to have the opportunity to answer this particular question.
And so, if one looks at what happens with a three-drug regimen—and so this is obviously one of the more recommended approaches right now, is to use a three-drug combination—and in this case, the patient had used a combination of Velcade, Cytoxan, and dexamethasone, and with this kind of a three-drug regimen, the improvement in Freelite and total protein occurs rather quickly. And so, within the first couple of months, the total protein, which includes the level of the myeloma protein or m-component as part of the total protein, this improves rather quickly and is typically back within normal in a couple of months.
Within the same time frame, the Freelite level is also improving, and in this case, it’s important to track which is the type of the Freelite which is linked to the myeloma, m-protein, for this particular patient. In this case, it was a kappa, and so one would expect the direct kappa level to improve within two or three months, and also, the ratio of the kappa to the normal light-chain level, the lamba, also to be moving towards normal.
It can take a little bit longer often for the ratio of the kappa to the lambda ratio to return to the full, normal range, and it might take three, four, five months. And so, the answer to the question, the bottom line is, that typically the Freelite and the total protein improve rather quickly if a good response is occurring within two or three months, and this can be tracked rather regularly.
The other aspect, just to add on here, is that patients are frequently very concerned if there are minor fluctuations in the light-chain levels along the way, and it is important to be aware that minor increases and decreases in the Freelite do occur from month to month, and these are not to be a source of worry because this is pretty common. Close to the normal range, there can be a slight increase, followed by a slight decrease, and these fluctuations are rather normal.
If there’s a bigger increase, it is important not to get overly alarmed without double-checking the result because again, with these fluctuations, double check and make sure that this is really a true value if the number has gone up rather than going down. And so, these are very important things to track. Typically if you’re doing well, the numbers go down within two or three months, so hopefully this is helpful for this particular patient and other patients that have this type of concern.