I was diagnosed with smoldering multiple myeloma about a year ago with an M-spike of 2.6 g/dL (26 g/L) and it has stayed at 2.6 for the last year. My plasma cell percentage on bone marrow biopsy (BMB) was 13%, IgG 3064 mg/dL, kappa-lambda FLC ratio is 45.
I would like to know what is considered a high M-spike? My numbers so far, at least for the last year, have been stable.
Thanks
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Re: What is a high M-spike?
Hello,
I see that you are smoldering multiple myeloma and that your numbers have been stable for the past year, which must be a relief.
I wonder, when you ask what is "high" what are you trying to ask? Are you concerned about your m-spike?
Any m-spike in the blood is technically "high" because it is not normal to have this. There are multiple myeloma patients who do not present with a "high" m-spike, but they have the disease nonetheless.
What I have learned in the is past year since my MGUS diagnosis (monoclonal gammopathy of undetermined significance) I have learned that the whole spectrum of this condition/disease process is quite complex and truly requires highly educated and committed physicians to sort out what is significant or a concern.
Most diagnoses of multiple myeloma are based on observation of many different tests, serum, urine, imaging, bone marrow biopsy, etc.
I wish I were saavy with linking previous discussions/articles from the Beacon because there are a lot of great resources here.
Are you concerned about your m-spike?
I see that you are smoldering multiple myeloma and that your numbers have been stable for the past year, which must be a relief.
I wonder, when you ask what is "high" what are you trying to ask? Are you concerned about your m-spike?
Any m-spike in the blood is technically "high" because it is not normal to have this. There are multiple myeloma patients who do not present with a "high" m-spike, but they have the disease nonetheless.
What I have learned in the is past year since my MGUS diagnosis (monoclonal gammopathy of undetermined significance) I have learned that the whole spectrum of this condition/disease process is quite complex and truly requires highly educated and committed physicians to sort out what is significant or a concern.
Most diagnoses of multiple myeloma are based on observation of many different tests, serum, urine, imaging, bone marrow biopsy, etc.
I wish I were saavy with linking previous discussions/articles from the Beacon because there are a lot of great resources here.
Are you concerned about your m-spike?
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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: What is a high M-spike?
Shall,
Your numbers are fairly close to my numbers (IgG Mspike=2.5 g/dL, BMP=11%, FLC Ratio= 20). My docs have always explained to me that it's really the overall trends that matter and not so much the absolute value of the M-spike. One of my specialists has classified me as "smoldering lite" based on my overall numbers, including my M-spike.
But if you still want to talk about a "high" threshold for an M-spike, I guess you could go back to old Durie Salmon staging criteria. For an M-spike to be considered "high" using the Durie Salmon staging system, an M-spike needed to be >7g/dL for an IgG-type M-spike or > 5 g/dL for an IgA-type M-spike. A "low" M-spike was considered to be <5g/dL or <3 g/dL for IgG and IgA-types, respectively.
But, in the end, it really comes down to whether you become symptomatic by meeting any of the CRABI criteria, or (depending on your own doctor's view of the new IMWG staging criteria) whether your FLC ratio is > 100, or your BMP % is > 60% or you develop more than one focal lesion >= 5mm....doesn't it?
Your numbers are fairly close to my numbers (IgG Mspike=2.5 g/dL, BMP=11%, FLC Ratio= 20). My docs have always explained to me that it's really the overall trends that matter and not so much the absolute value of the M-spike. One of my specialists has classified me as "smoldering lite" based on my overall numbers, including my M-spike.
But if you still want to talk about a "high" threshold for an M-spike, I guess you could go back to old Durie Salmon staging criteria. For an M-spike to be considered "high" using the Durie Salmon staging system, an M-spike needed to be >7g/dL for an IgG-type M-spike or > 5 g/dL for an IgA-type M-spike. A "low" M-spike was considered to be <5g/dL or <3 g/dL for IgG and IgA-types, respectively.
But, in the end, it really comes down to whether you become symptomatic by meeting any of the CRABI criteria, or (depending on your own doctor's view of the new IMWG staging criteria) whether your FLC ratio is > 100, or your BMP % is > 60% or you develop more than one focal lesion >= 5mm....doesn't it?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: What is a high M-spike?
I was diagnosed with "advanced" myeloma in 2010 and had a high m-spike which was 9.8 g/dL (or 98 g/L in Canada, where I live). The doctor said this was pretty high, and It caused some other rarer myeloma issues being so high.
Now I am hovering around 0.5 g/dL M-spike. So still a relapse for me, but in something of a smoldering state at the moment since I don't have any symptoms yet. Maybe some back pain, but it's hard to tell.
Now I am hovering around 0.5 g/dL M-spike. So still a relapse for me, but in something of a smoldering state at the moment since I don't have any symptoms yet. Maybe some back pain, but it's hard to tell.
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lys2012 - Name: Alyssa
- When were you/they diagnosed?: 2010, Toronto, Canada
- Age at diagnosis: 32
Re: What is a high M-spike?
I guess there are at least two ways you can approach answering the question "what is a high M-spike?"
One way is to answer it in terms of whether or not a certain M-spike level is high compared to what is normally seen with people with the same diagnosis that you have.
Another way is to answer the question in terms of what level of an M-spike is just patently unhealthy / dangerous given what the elevated levels of immunoglobulin can do to the body.
To answer the question taking the first approach, you can look at some of the polls that were done here in the forum, asking about M-spikes at diagnosis. There have been separate polls for smoldering myeloma and symptomatic multiple myeloma:
https://myelomabeacon.org/forum/weekly-poll-smoldering-myeloma-m-spike-t2286.html
https://myelomabeacon.org/forum/weekly-poll-m-spike-at-diagnosis-2014-t3136.html
and also a poll for MGUS patients asking what their M-spike currently is (if their M-spike is stable)
https://myelomabeacon.org/forum/weekly-poll-mgus-m-spike-t2285.html
For smoldering myeloma, you'll see that most of the M-spikes are in the 1-2 g/dL range, but a fifth of the people who answered the poll had an M-spike above 2 g/dL.
For multiple myeloma, the range of M-spikes is much greater, with about a third having an M-spike less than 2 g/dL, a third between 2 and 4, and a third higher.
As to what level of M-spike is "high" in the sense of being unhealthy, lys2012's answer gives a sense of that. My impression is that, when you're talking M-spikes above 5 or 6 g/dL, you're in the range of clearly unhealthy M-spike levels.
Keep in mind that about 15-20 percent of myeloma patients don't have an M-spike, but instead just have elevated levels of their free light chains. And very high free light chain levels can do a lot of damage to the body, especially the kidneys.
One way is to answer it in terms of whether or not a certain M-spike level is high compared to what is normally seen with people with the same diagnosis that you have.
Another way is to answer the question in terms of what level of an M-spike is just patently unhealthy / dangerous given what the elevated levels of immunoglobulin can do to the body.
To answer the question taking the first approach, you can look at some of the polls that were done here in the forum, asking about M-spikes at diagnosis. There have been separate polls for smoldering myeloma and symptomatic multiple myeloma:
https://myelomabeacon.org/forum/weekly-poll-smoldering-myeloma-m-spike-t2286.html
https://myelomabeacon.org/forum/weekly-poll-m-spike-at-diagnosis-2014-t3136.html
and also a poll for MGUS patients asking what their M-spike currently is (if their M-spike is stable)
https://myelomabeacon.org/forum/weekly-poll-mgus-m-spike-t2285.html
For smoldering myeloma, you'll see that most of the M-spikes are in the 1-2 g/dL range, but a fifth of the people who answered the poll had an M-spike above 2 g/dL.
For multiple myeloma, the range of M-spikes is much greater, with about a third having an M-spike less than 2 g/dL, a third between 2 and 4, and a third higher.
As to what level of M-spike is "high" in the sense of being unhealthy, lys2012's answer gives a sense of that. My impression is that, when you're talking M-spikes above 5 or 6 g/dL, you're in the range of clearly unhealthy M-spike levels.
Keep in mind that about 15-20 percent of myeloma patients don't have an M-spike, but instead just have elevated levels of their free light chains. And very high free light chain levels can do a lot of damage to the body, especially the kidneys.
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Jonah
5 posts
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