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Is IgA multiple myeloma more aggressive?
Just wondering (given Dr.Landau's reply on a previous thread) if it has been shown that IgA is more aggressive. She also mentioned IgA myeloma is more in younger people and I'm wondering what the definition of "younger" is?
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gardengirl - Name: gardengirl
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Nov. 2013
- Age at diagnosis: 47
Re: Is IgA multiple myeloma more aggressive?
Gardengirl,
There might be a professional difference of opinion on this subject
"IgA multiple myeloma, Stage 3A", Beacon forum discussion started October 16, 2013.
There might be a professional difference of opinion on this subject
"IgA multiple myeloma, Stage 3A", Beacon forum discussion started October 16, 2013.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Is IgA multiple myeloma more aggressive?
Hi there,
I am 38 and I have IgA MGUS, would this mean I have a more aggressive type of MGUS? I don't know any of my FISH, had a BMB 6 months ago, and didn't get any of that information. So is IgA more aggressive than the other types? I am really confused right now. Thank you.
I am 38 and I have IgA MGUS, would this mean I have a more aggressive type of MGUS? I don't know any of my FISH, had a BMB 6 months ago, and didn't get any of that information. So is IgA more aggressive than the other types? I am really confused right now. Thank you.
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Ted M.
Re: Is IgA multiple myeloma more aggressive?
Ted - Having a non-IgG type of MGUS (such as IgA) is often considered one of a couple risk factors for a higher rate of progression from MGUS to symptomatic disease such as multiple myeloma. But it's only one risk factor, and, of course, each's person's disease is unique.
The additional risk associated with non-IgG MGUS cases was described in this oft-cited paper from Mayo Clinic researchers,
SV Rajkumar, "Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance", Blood, August 1, 2005; 106 (3) (full text available online at no charge).
See, in particular, Figure 3 in the paper and the explanation along with it, which describes the so-called "Mayo model" of progression risk for MGUS,
"The top curve illustrates risk of progression with time in patients with all 3 risk factors, namely an abnormal serum kappa-lambda FLC ratio (< 0.26 or > 1.65), a high serum monoclonal protein level (≥ 15 g/L), and non–IgG MGUS; the second gives the risk of progression in patients with any 2 of these risk factors; the third curve illustrates the risk of progression with one of these risk factors; the bottom curve is the risk of progression for patients with none of the risk factors."
Key parts of the Mayo model – with the non-IgG risk factor for progression – is also incorporated into the International Myeloma Working Group's 2010 guidelines for risk of progression and monitoring for MGUS, which you can read about in this Beacon article:
"MGUS And Smoldering Multiple Myeloma: Experts Identify Risk Factors For Disease Progression And Establish Monitoring Guidelines – Part 1: MGUS", Myeloma Beacon, August 16, 2010.
Remember that you can find all Beacon articles related to MGUS at this topic (tag) page:
https://myelomabeacon.org/tag/mgus/
The additional risk associated with non-IgG MGUS cases was described in this oft-cited paper from Mayo Clinic researchers,
SV Rajkumar, "Serum free light chain ratio is an independent risk factor for progression in monoclonal gammopathy of undetermined significance", Blood, August 1, 2005; 106 (3) (full text available online at no charge).
See, in particular, Figure 3 in the paper and the explanation along with it, which describes the so-called "Mayo model" of progression risk for MGUS,
"The top curve illustrates risk of progression with time in patients with all 3 risk factors, namely an abnormal serum kappa-lambda FLC ratio (< 0.26 or > 1.65), a high serum monoclonal protein level (≥ 15 g/L), and non–IgG MGUS; the second gives the risk of progression in patients with any 2 of these risk factors; the third curve illustrates the risk of progression with one of these risk factors; the bottom curve is the risk of progression for patients with none of the risk factors."
Key parts of the Mayo model – with the non-IgG risk factor for progression – is also incorporated into the International Myeloma Working Group's 2010 guidelines for risk of progression and monitoring for MGUS, which you can read about in this Beacon article:
"MGUS And Smoldering Multiple Myeloma: Experts Identify Risk Factors For Disease Progression And Establish Monitoring Guidelines – Part 1: MGUS", Myeloma Beacon, August 16, 2010.
Remember that you can find all Beacon articles related to MGUS at this topic (tag) page:
https://myelomabeacon.org/tag/mgus/
Re: Is IgA multiple myeloma more aggressive?
My apologies for not clarifying this comment when stated.
While not ALL IgA disease is aggressive or occurs in "younger" (it's all perspective) patients, IgA disease has been associated with t (4;14) and other "unfavorable" cytogenetics – which are likely the drivers of the aggressive phenotype, rather than the IgA per se. See references below:
P Moreau et al, "Recurrent 14q32 translocations determine the prognosis of multiple myeloma, especially in patients receiving intensive chemotherapy," Blood, September 1, 2002; 100 (5) (abstract & full text, full text as PDF)
G Tricot et al, "Poor prognosis in multiple myeloma is associated only with partial or complete deletions of chromosome 13 or abnormalities involving 11q and not with other karyotype abnormalities," Blood, December 1, 1995; 86 (11) (abstract, full text as PDF)
As for IgA MGUS, again, not ALL IgA MGUS progresses to a more active hematologic condition. Rather, as the Beacon Staff so nicely pointed out, it is just ONE risk factor for progression. Certainly, if it is your ONLY risk factor, your risk of developing a more active disorder is only 20% over 20 years, meaning that there is an 80% chance that you will NOT progress.
Hope this helps!
While not ALL IgA disease is aggressive or occurs in "younger" (it's all perspective) patients, IgA disease has been associated with t (4;14) and other "unfavorable" cytogenetics – which are likely the drivers of the aggressive phenotype, rather than the IgA per se. See references below:
P Moreau et al, "Recurrent 14q32 translocations determine the prognosis of multiple myeloma, especially in patients receiving intensive chemotherapy," Blood, September 1, 2002; 100 (5) (abstract & full text, full text as PDF)
G Tricot et al, "Poor prognosis in multiple myeloma is associated only with partial or complete deletions of chromosome 13 or abnormalities involving 11q and not with other karyotype abnormalities," Blood, December 1, 1995; 86 (11) (abstract, full text as PDF)
As for IgA MGUS, again, not ALL IgA MGUS progresses to a more active hematologic condition. Rather, as the Beacon Staff so nicely pointed out, it is just ONE risk factor for progression. Certainly, if it is your ONLY risk factor, your risk of developing a more active disorder is only 20% over 20 years, meaning that there is an 80% chance that you will NOT progress.
Hope this helps!
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Dr. Heather Landau - Name: Heather Landau, M.D.
Beacon Medical Advisor
Re: Is IgA multiple myeloma more aggressive?
Thank you, Dr. Landau, for that clarification! I feel much better now! 
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gardengirl - Name: gardengirl
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Nov. 2013
- Age at diagnosis: 47
Re: Is IgA multiple myeloma more aggressive?
I'm see a lot of info on this thread regarding IgA MGUS but what if it's active IgA myeloma? Would it then mean a worse prognosis? Would an older patient also be a factor?
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