[Lacerta]

Lab results - is it plasma cell leukemia?

by Lacerta on Sun Nov 29, 2015 4:30 pm

Hi,

My mother at the age of 59 has multiple myeloma and possible plasma cell leukemia. However, the doctors at the local hospital are not that experienced with myeloma and they haven't been good with information. It's little more than a month since she was hospitalized due to kidney failure and anemia, and they soon suspected myeloma.

They haven't been clear to me whether she has plasma cell leukemia in addition; some doctors said yes, and some doctors said they weren't sure.

I have now got all the lab results from the university and I hope someone here could help me to understand if she has plasma cell leukemia in addition, and which stage of myeloma.

I have included values that deviates from the reference range:

Table 1
----------------------------------------------
Test Oct 26, 2015 Nov 03, 2015
----------------------------------------------
Beta2-globulin 2.4 g/L
Beta2-globulin 1.2 g/L
Gamma-globulin 38.6 g/L
IgG 37 g/L
IgG 65.9 g/L
IgA 0.21 g/L
Ig kappa free 4610 mg/L 77.7 mg/L
Ig lamda free 1.4 mg/L 13.8 mg/L
kappa/lambda ratio 3414.8 5.6
----------------------------------------------

Note: I find the change in Ig kappa/lamda to be very strange, only one week between, but I know she got trombocytes and combination of Velcade (bortezomib) and dexamethasone.

Table 2
------------------------------
Test Nov 23, 2015
------------------------------
Lymphocytes 0.37 10E9/L
Basophils 88 10E9/L
Calcium (total) 1.87 mmol/L
Magnesium 0.52 mmol/L
Carbamide 9.5 mmol/L
Albumin 28 g/L
------------------------------

And in addition:

Beta 2-microglobulin 4.3 mg/L (Nov 5, 2015)
Bone marrow biopsy plasma cells 80%, date unknown, but somewhere between Oct 23-28, 2015
Translocation t(14;16) (Oct 23, 2015)
No bone lesions (Nov 3, 2015)

Hope if this values can tell myeloma stage and if she has plasma cell leukemia in addition?

Regards,
Ron

[Multibilly]

Re: Lab results - is it plasma cell leukemia?

by Multibilly on Sun Nov 29, 2015 6:27 pm

Hi Ron,

Welcome to the forum.

One of the key tests for plasma cell leukemia (PCL) is to measure the percentage and number of plasma cells circulating in one's blood serum (not in the bone marrow). This would have been one of the first tests a doctor would do if he/she suspected PCL.

I'm not a doc and not intimately familiar with PCL, but I don't believe you can tell from the specific test results that you listed whether PCL would be suspected. Doctors may suspect PCL based on specific flow cytometry results (part of the bone marrow biopsy tests), increased lymphocytes, elevated LDH, etc. But your mom's doctor really needs to say why he/she suspects PCL in the first place, rather than try to guess at it on a forum like this.

If her doctors aren't that familiar with multiple myeloma or PCL, I would strongly encourage getting a consult with a multiple myeloma specialist. If you let us know what city your mom is in, folks on this site can make some recommendations as to where to find these specialists.

Lastly, stage is not that critical to understand with multiple myeloma, as long as she is getting the right treatment and is responding. But there are a lot of nuances to getting the right treatment for a given multiple myeloma patient and it pays to be working with a top multiple myeloma specialist.

[Lacerta]

Re: Lab results - is it plasma cell leukemia?

by Lacerta on Sun Nov 29, 2015 6:43 pm

Thanks for reply.

I'm from Norway and it has been a bad experience with the doctors in terms of myeloma information.

I contacted a specialist in Norway, and in fact he responded just now while I'm writing. The serum values did not indicate plasma cell leukemia.

I think this is the important value: Leukocytes 6.6 10E9/L ?

Regards,
Ron

[Cheryl G]

Re: Lab results - is it plasma cell leukemia?

by Cheryl G on Sun Nov 29, 2015 7:33 pm

Hi Ron,

You can find a list of leading myeloma specialists in countries around the world in this forum thread:

https://myelomabeacon.org/forum/international-myeloma-working-group-imwg-members-t3514.html

There is one in Norway -- Dr. Anders Waage in Trondheim.

This article has the criteria for a plasma cell leukemia diagnosis:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112539/

You also may find this article helpful:

http://www.bloodjournal.org/content/120/12/2376.full

My understanding from the article and other reading is that a diagnosis of plasma cell leukemia is made when either 20 percent or more of the white cells in the blood are plasma cells, or the absolute plasma cell count in the blood is more than 2 billion (10^9) per liter.

Just for future reference, the Wikipedia article on plasma cell leukemia also has some useful information, particularly about the markers on plasma cells in the case of PCL versus multiple myeloma:

https://en.wikipedia.org/wiki/Plasma_cell_leukemia

Good luck!

[Lacerta]

Re: Lab results - is it plasma cell leukemia?

by Lacerta on Sun Nov 29, 2015 8:21 pm

Thanks for reply. I got reply from Dr. Waage. From the laboratory report he said there was no indication of PCL. Although, since the serum values is from after she started with treatment it might not be proper for diagnosing PCL, I have to ask him once more.