My husband has been in "stringent CR" since 100 days post transplant (February 2014). We went to a new oncologist yesterday who tested his IgA levels, which were elevated at 725. They haven't been tested since February, at which time were around 70.
Electrophoresis is still pending, but I assume the elevated IgA means relapse?
Forums
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: Elevated IgA level - sign of relapse?
I'll await others thoughts on this situation, but I'll ask the first question. Why was a period of six months allowed between blood work?
I hope for all the best to your husband during this potential setback. I had my ASCT in March and have at a minimum a CBC every month.
Stay positive!
Kully
I hope for all the best to your husband during this potential setback. I had my ASCT in March and have at a minimum a CBC every month.
Stay positive!
Kully
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kullybunnny1 - Name: Kully
- Who do you know with myeloma?: me
- When were you/they diagnosed?: August 2013
- Age at diagnosis: 48
Re: Elevated IgA level - sign of relapse?
He did have SPEP and IFE monthly, they just didn't moniter immunoglobulins for some reason. He has had no M spike negative IFE and normal kappa/lambda ratio every month since transplant.
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: Elevated IgA level - sign of relapse?
I am IgA as well. I also had ASCT in February.
At my 100 day follow-up in June, my doctor indicated that tracking IgA levels to measure "disease burden" is more important for IgA patients than tracking M-spike. The IgA protein is rather large (about twice as large as other monoclonal proteins). As a result, it is somewhat more difficult to quantify on M-spike that the other proteins.
Keep in mind that there is a subjective element in M Spike evaluation - the pathologist must "estimate" M spike levels (graphic peaks) to some degree. This partially explains variations across measurements and across labs, I presume. IgA is "easier" to quantify, apparently.
Got my numbers yesterday - IgA is 260 (within normal range) and M Spike is 0.1. For me, Revlimid has been much more important in getting my disease burden lowered than transplant. Either way, I'll take it, although CR would be nice.
Perhaps others here can confirm my statements about the size of the IgA protein and the related measurement challenges. But in short, it seems that IgA level is key in monitoring of IgA multiple myeloma. I get IgA testing (and M Spike) every other month while in maintenance, which began last month (10 mg Revlimid).
At my 100 day follow-up in June, my doctor indicated that tracking IgA levels to measure "disease burden" is more important for IgA patients than tracking M-spike. The IgA protein is rather large (about twice as large as other monoclonal proteins). As a result, it is somewhat more difficult to quantify on M-spike that the other proteins.
Keep in mind that there is a subjective element in M Spike evaluation - the pathologist must "estimate" M spike levels (graphic peaks) to some degree. This partially explains variations across measurements and across labs, I presume. IgA is "easier" to quantify, apparently.
Got my numbers yesterday - IgA is 260 (within normal range) and M Spike is 0.1. For me, Revlimid has been much more important in getting my disease burden lowered than transplant. Either way, I'll take it, although CR would be nice.
Perhaps others here can confirm my statements about the size of the IgA protein and the related measurement challenges. But in short, it seems that IgA level is key in monitoring of IgA multiple myeloma. I get IgA testing (and M Spike) every other month while in maintenance, which began last month (10 mg Revlimid).
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wesley - Who do you know with myeloma?: me
- When were you/they diagnosed?: July, 2013
- Age at diagnosis: 60
Re: Elevated IgA level - sign of relapse?
The IFE done at the same time as the elevated IgA is saying negative (no para-proteins detected).
So very confused!
So very confused!
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: Elevated IgA level - sign of relapse?
The tests I would put most stock in would be the sFLC (Freelite) assay, SPEP, and IFE. If all of these come back negative or normal, then I would not worry about it. The total protein test is less specific.
The other things I would look at is creatinine levels and calcium levels. If these are normal, then kidney function is normal and with normal calcium, lytic lesions are not likely forming.
Then, finally, if his CBC shows no anemia ,then the conclusion has to be that myeloma is not active.
Don't put so much stock in one test, you must look at the entire picture.
Ron
The other things I would look at is creatinine levels and calcium levels. If these are normal, then kidney function is normal and with normal calcium, lytic lesions are not likely forming.
Then, finally, if his CBC shows no anemia ,then the conclusion has to be that myeloma is not active.
Don't put so much stock in one test, you must look at the entire picture.
Ron
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Elevated IgA level - sign of relapse?
Hi Blair,
Was your husband initially diagnosed with IgA type myeloma?
Was your husband initially diagnosed with IgA type myeloma?
Re: Elevated IgA level - sign of relapse?
blair77, I'm sorry you and your husband are going through this.
This is very confusing. As others have mentioned, for those patients with IgA disease, sometimes it is hard for the pathologist to recognize the paraprotein on the SPEP. And that is why testing the IgA is important. Not infrequently, we will see patients who have reports of 0 paraprotein on the SPEP and the IgA is over 600. In those cases, though, if a paraprotein is present, the immunofixation (IFE) will confirm the presence of the paraprotein.
Based on the information provided, it is hard to know now. I suggest repeating the tests soon. That's what I do when the tests I order don't make sense.
My best,
Jlk
This is very confusing. As others have mentioned, for those patients with IgA disease, sometimes it is hard for the pathologist to recognize the paraprotein on the SPEP. And that is why testing the IgA is important. Not infrequently, we will see patients who have reports of 0 paraprotein on the SPEP and the IgA is over 600. In those cases, though, if a paraprotein is present, the immunofixation (IFE) will confirm the presence of the paraprotein.
Based on the information provided, it is hard to know now. I suggest repeating the tests soon. That's what I do when the tests I order don't make sense.
My best,
Jlk
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Dr. Jonathan Kaufman - Name: Jonathan Kaufman, M.D.
Beacon Medical Advisor
Re: Elevated IgA level - sign of relapse?
Can IgA be elevated in other conditions? If the elevation is polyclonal in origin would it then not be detected as a paraprotein?
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: Elevated IgA level - sign of relapse?
They rechecked the immunoglobulins 3 weeks later to see if the IgA had remained stable or decreased. It rose 9 points (725 to 734), IgG also rose by 100 points (1340 to 1440) and IgM (74 to 79).
They didn't rerun the myeloma labs.
His hemoglobin also rose from 12.9 to 13.6 and RBC 3.9 to 4.06 (he is on Revlimid maintenance).
What does a rise in all the immunoglobulins mean? All his lab work seems to contradict itself. Any insights?
They didn't rerun the myeloma labs.
His hemoglobin also rose from 12.9 to 13.6 and RBC 3.9 to 4.06 (he is on Revlimid maintenance).
What does a rise in all the immunoglobulins mean? All his lab work seems to contradict itself. Any insights?
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
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