I have had MGUS for about 3-4 years. I'm a 59 year old female, abnormal protein of 1.0 g/dL, sed rate was 86 2 weeks ago, now 90, platelets 133.
My doctor is concerned with the sed rate, which is an unexplained elevation at this point. Last year it was 36. He is considering a bone marrow biopsy. My immunoglobulins are within normal range.
Would a bone marrow biopsy be appropriate at this stage?
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Re: Have MGUS, wondering if should have bone marrow biopsy
Oh my, I just posted last night about whether to have bone marrow biopsy with an M-spike of 1.0. I was only diagnosed 3 months ago and I've just come across this forum yesterday.
I have little knowledge yet about MGUS and you likely have much more. I just met with my oncologist this morning and he still feels it is unnecessary for me to have a BMB. However, after reading many posts on these boards, I am beginning to think it would be a good idea to have one.
What I understand now is that a BMB doesn't just show the extent of the cellular change, but also gives you genetic information which helps to understand causes and plan for treatment if necessary.
It looks like most prudent clinicians and patients have at least one BMB at baseline or if there are changes because so much information can be gleaned from it.
Since some of your work up is showing changes, it probably would be a good idea to have one.
Best of luck and I hope you get more replies soon to help you with your decision.
I have little knowledge yet about MGUS and you likely have much more. I just met with my oncologist this morning and he still feels it is unnecessary for me to have a BMB. However, after reading many posts on these boards, I am beginning to think it would be a good idea to have one.
What I understand now is that a BMB doesn't just show the extent of the cellular change, but also gives you genetic information which helps to understand causes and plan for treatment if necessary.
It looks like most prudent clinicians and patients have at least one BMB at baseline or if there are changes because so much information can be gleaned from it.
Since some of your work up is showing changes, it probably would be a good idea to have one.
Best of luck and I hope you get more replies soon to help you with your decision.
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
Re: Have MGUS, wondering if should have bone marrow biopsy
Emmylou and Toni,
As a physician who sees many patients with MGUS, I frequently have this discussion. In general, I recommend a bone marrow biopsy for most if not all patients with a new monoclonal protein (m-protein, m-spike, monoclonal protein, paraprotein). The bone marrow biopsy is helpful for two reasons.
Firstly, it can confirm the diagnosis of MGUS, as long as the percentage of plasma cells is less than 10%, as opposed to smoldering myeloma, where the percentage is 10% or greater. This is helpful for defining prognosis and risk of progression to symptomatic myeloma. While not exact, MGUS patients have a risk of progression of 1% per year and smoldering myeloma patients have about a 10% per year risk (many more details about this are available).
The second point is one of understanding the underlying genetics of the MGUS. This is typically done with FISH testing and cytogenetics. While today we don't make decisions based on that information, I am confident that one day we will.
That was a very long way of saying "yes", you should have a bone marrow biopsy.
Best wishes,
Jlk
As a physician who sees many patients with MGUS, I frequently have this discussion. In general, I recommend a bone marrow biopsy for most if not all patients with a new monoclonal protein (m-protein, m-spike, monoclonal protein, paraprotein). The bone marrow biopsy is helpful for two reasons.
Firstly, it can confirm the diagnosis of MGUS, as long as the percentage of plasma cells is less than 10%, as opposed to smoldering myeloma, where the percentage is 10% or greater. This is helpful for defining prognosis and risk of progression to symptomatic myeloma. While not exact, MGUS patients have a risk of progression of 1% per year and smoldering myeloma patients have about a 10% per year risk (many more details about this are available).
The second point is one of understanding the underlying genetics of the MGUS. This is typically done with FISH testing and cytogenetics. While today we don't make decisions based on that information, I am confident that one day we will.
That was a very long way of saying "yes", you should have a bone marrow biopsy.
Best wishes,
Jlk
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Dr. Jonathan Kaufman - Name: Jonathan Kaufman, M.D.
Beacon Medical Advisor
Re: Have MGUS, wondering if should have bone marrow biopsy
Dr. Kaufman:
Thank you so very much for taking the time to reply!
I have been on the fence about a BMB because of fear of the procedure. But, because I have frequent persistent pain, especially in the vertebrae, hips, etc., my husband has encouraged me to have it done if for nothing else than to alleviate any worry at this point.
Is it true that it's best to seek out an oncologist/hematologist who has a specialization in myeloma? My understanding is that this can make a difference in terms of the degree of information you get from the tests and the ways in which they are interpreted.
Once again, many thanks for your input.
Toni
Thank you so very much for taking the time to reply!
I have been on the fence about a BMB because of fear of the procedure. But, because I have frequent persistent pain, especially in the vertebrae, hips, etc., my husband has encouraged me to have it done if for nothing else than to alleviate any worry at this point.
Is it true that it's best to seek out an oncologist/hematologist who has a specialization in myeloma? My understanding is that this can make a difference in terms of the degree of information you get from the tests and the ways in which they are interpreted.
Once again, many thanks for your input.
Toni
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Toni - Name: Toni
- Who do you know with myeloma?: self - MGUS
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 51
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