I am at Day +100 after completing an autologous stem cell transplant and my M-spike results on my urine sample showed "not observed." However, on my blood work it showed 0.4 g/dL (4 g/l).
Waiting on a PET Scan result.
Very confused.
Forums
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Tigerboy74 - Name: Mike
- Who do you know with myeloma?: Me and few others
- When were you/they diagnosed?: 2007
- Age at diagnosis: 32
Re: 100 days post SCT - M-spike in blood but not in urine
Mike,
While the monoclonal protein in the urine and the blood serum are both referred to as "M-spikes", they measure very different things. The serum M-spike measures monoclonal heavy chains (e.g. monoclonal IgG, IgA, IgM, etc). The urine M-spike measures monoclonal free light chains (aka Bence Jones proteins or monoclonal lambda or kappa free light chains).
So, it is very possible that you aren't producing enough free light chains for them to spill over into your urine and be measured as a urine M-spike (which is good news on the free light chain front). But you apparently are still producing enough monoclonal heavy chains and/or have some older ones floating around for them to still be measured in your blood.
In any case, it's totally possible that the presence of the serum M-spike is due to normal immune system reconstitution and it may still disappear over the coming months. You should also check your immunofixation test results to see if the M-spike that is currently there is the same type (e.g. IgA-lambda, etc) that you had before the transplant, or if you have multiple M-spikes.
While the monoclonal protein in the urine and the blood serum are both referred to as "M-spikes", they measure very different things. The serum M-spike measures monoclonal heavy chains (e.g. monoclonal IgG, IgA, IgM, etc). The urine M-spike measures monoclonal free light chains (aka Bence Jones proteins or monoclonal lambda or kappa free light chains).
So, it is very possible that you aren't producing enough free light chains for them to spill over into your urine and be measured as a urine M-spike (which is good news on the free light chain front). But you apparently are still producing enough monoclonal heavy chains and/or have some older ones floating around for them to still be measured in your blood.
In any case, it's totally possible that the presence of the serum M-spike is due to normal immune system reconstitution and it may still disappear over the coming months. You should also check your immunofixation test results to see if the M-spike that is currently there is the same type (e.g. IgA-lambda, etc) that you had before the transplant, or if you have multiple M-spikes.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: 100 days post SCT - M-spike in blood but not in urine
Funny you talk about that. I was IgG high prior to the stem cell transplant, and now IgA low, 36 mg/dl.
My ratios are as follows:
Free Kappa Lt. Chains - 11.13 mg/L
Free Lambda Lt. Chains - 4.02
Kappa/Lambda Ratio - 2.77
All my MRIs except my shoulder are free and clear, along with bone marrow and skeletal.
Left should still have 2 cm lesion from a plasmacytoma there. I would have thought the high dose would have killed it off.
I will get full results on Monday. My nurse practitioner told me not to worry about it.
My ratios are as follows:
Free Kappa Lt. Chains - 11.13 mg/L
Free Lambda Lt. Chains - 4.02
Kappa/Lambda Ratio - 2.77
All my MRIs except my shoulder are free and clear, along with bone marrow and skeletal.
Left should still have 2 cm lesion from a plasmacytoma there. I would have thought the high dose would have killed it off.
I will get full results on Monday. My nurse practitioner told me not to worry about it.
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Tigerboy74 - Name: Mike
- Who do you know with myeloma?: Me and few others
- When were you/they diagnosed?: 2007
- Age at diagnosis: 32
Re: 100 days post SCT - M-spike in blood but not in urine
Everything came back free and clear.
No activity in my PET scan where I originally had my 2 spots, nothing in the MRI, nothing in the skeletal xray. I did not do a bone marrow biopsy though.
I still though have an M-spike of 0.4 g/dL (4 g/L), which is a concern.
We talked about a tandem transplant or doing 3 more rounds of chemo.
Due to my situation, I am going the chemo route for now and am getting a bone marrow biopsy on Friday.
This guy is hiding in me somewhere. I am beyond frustrated since I feel great!
Has anyone experienced this? What do you think it can be?
No activity in my PET scan where I originally had my 2 spots, nothing in the MRI, nothing in the skeletal xray. I did not do a bone marrow biopsy though.
I still though have an M-spike of 0.4 g/dL (4 g/L), which is a concern.
We talked about a tandem transplant or doing 3 more rounds of chemo.
Due to my situation, I am going the chemo route for now and am getting a bone marrow biopsy on Friday.
This guy is hiding in me somewhere. I am beyond frustrated since I feel great!
Has anyone experienced this? What do you think it can be?
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Tigerboy74 - Name: Mike
- Who do you know with myeloma?: Me and few others
- When were you/they diagnosed?: 2007
- Age at diagnosis: 32
Re: 100 days post SCT - M-spike in blood but not in urine
Mike,
Have some patience with your test results. Although most people show responses within the 100 days post transplant, not everyone does. I didn't have a drop in my M-spike from pre-transplant levels until month 6 when it dropped to 0 from 0.5 g/dL. All of my other blood work was improving during that time, but was still abnormal until that 6th month.
Your decision to do consolidation sounds like it probably is a good one. Sometimes I think that the doctors rush to more treatment, such as another transplant, too soon. Our bodies aren't necessarily tuned in to the 100 day deadline that has been imposed on us.
All the best with your next treatment,
Nancy in Phila
Have some patience with your test results. Although most people show responses within the 100 days post transplant, not everyone does. I didn't have a drop in my M-spike from pre-transplant levels until month 6 when it dropped to 0 from 0.5 g/dL. All of my other blood work was improving during that time, but was still abnormal until that 6th month.
Your decision to do consolidation sounds like it probably is a good one. Sometimes I think that the doctors rush to more treatment, such as another transplant, too soon. Our bodies aren't necessarily tuned in to the 100 day deadline that has been imposed on us.
All the best with your next treatment,
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: 100 days post SCT - M-spike in blood but not in urine
Thanks, Nancy, your situation puts me at ease. I'm just more frustrated than anything.
I am about to get a hip replacement, which now is on hold due to this.
Also all during last year, with my cancer and stem cell transplant I was going through a divorce and was able to get full custody of my 2 boys. When life gives you lemons, make lemonade!
By the way, I used to live in Bethlehem, Pennsylvania, and have been to Philly; best cheesesteak is at Jim's.
Mike
I am about to get a hip replacement, which now is on hold due to this.
Also all during last year, with my cancer and stem cell transplant I was going through a divorce and was able to get full custody of my 2 boys. When life gives you lemons, make lemonade!
By the way, I used to live in Bethlehem, Pennsylvania, and have been to Philly; best cheesesteak is at Jim's.
Mike
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Tigerboy74 - Name: Mike
- Who do you know with myeloma?: Me and few others
- When were you/they diagnosed?: 2007
- Age at diagnosis: 32
Re: 100 days post SCT - M-spike in blood but not in urine
I've started my chemo back yesterday and I was pleased to hear that my bone marrow came back at "zero". They can do an additional test on my bone marrow that breaks down the percentages further and I was at 0.01% of protein cells. That is 1/100 or 1% in my bone marrow! I can't be any happier.
I don't seem too concerned about my M-spike being at 0.04 g/dL and hoping that 3 rounds can knock it back to zero.
Would any of you do a tandem with clear results on PET, MRI, skeletal, bone marrow and a 0.04 g/dL M-spike?
Any other opinions or feedback would be helpful.
Thanks and fight on!
Mike
I don't seem too concerned about my M-spike being at 0.04 g/dL and hoping that 3 rounds can knock it back to zero.
Would any of you do a tandem with clear results on PET, MRI, skeletal, bone marrow and a 0.04 g/dL M-spike?
Any other opinions or feedback would be helpful.
Thanks and fight on!
Mike
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Tigerboy74 - Name: Mike
- Who do you know with myeloma?: Me and few others
- When were you/they diagnosed?: 2007
- Age at diagnosis: 32
Re: 100 days post SCT - M-spike in blood but not in urine
Personally, I wouldn't . Your results seem very good to me, and as Nancy said, it can be many months before the M-protein drops. If you're doing more consolidation treatment, that should certainly help with the small monoclonal protein. Of course, that's just my opinion.
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Christina - Name: Christina
- When were you/they diagnosed?: June2005
- Age at diagnosis: 52
Re: 100 days post SCT - M-spike in blood but not in urine
Tigerboy
Those look like excellent results.
I thought tandem transplants were done in a relatively short period of time, and in most cases pre-approved by insurance. Looks like you might be approaching 120 days, or 4 months, and I'm not sure insurance would approve another with your response. You may inquire with them before analyzing in too much depth (I know that's easier said than done).
How did you move the decimal point in "and I was at 0.01% of protein cells. That is 1/100 or 1%'
Isn't 0.01% equal to one in ten thousand?
1%=1/100
0.1%=1/1000
0.01%=1/10000
Those look like excellent results.
I thought tandem transplants were done in a relatively short period of time, and in most cases pre-approved by insurance. Looks like you might be approaching 120 days, or 4 months, and I'm not sure insurance would approve another with your response. You may inquire with them before analyzing in too much depth (I know that's easier said than done).
How did you move the decimal point in "and I was at 0.01% of protein cells. That is 1/100 or 1%'
Isn't 0.01% equal to one in ten thousand?
1%=1/100
0.1%=1/1000
0.01%=1/10000
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
Re: 100 days post SCT - M-spike in blood but not in urine
Tigerboy,
I realized I didn't answer your question regarding a second transplant. I did a tandem transplant, so yes, I would pursue a second transplant. I was 54 years old.
A myeloma specialist in our area recently gave a presentation where he said that, under certain circumstances, an autologous stem cell transplant would only result in X more months/years of survival (it doesn't really matter what X was). I spoke up and said that there were patients there who hadn't had a transplant, but that I would do another transplant for X more months/years. More younger people than older people at the presentation agreed with my statement of repeating a transplant for X months / years.
Since you are young and know how you handled your first stem cell transplant, you probably already have an opinion. Then I asked if there was a limit to the number of autologous transplants, and he mentioned he has heard of people having 4 and 6 transplants, although I'm not certain they were all autologous transplants.
Best wishes
I realized I didn't answer your question regarding a second transplant. I did a tandem transplant, so yes, I would pursue a second transplant. I was 54 years old.
A myeloma specialist in our area recently gave a presentation where he said that, under certain circumstances, an autologous stem cell transplant would only result in X more months/years of survival (it doesn't really matter what X was). I spoke up and said that there were patients there who hadn't had a transplant, but that I would do another transplant for X more months/years. More younger people than older people at the presentation agreed with my statement of repeating a transplant for X months / years.
Since you are young and know how you handled your first stem cell transplant, you probably already have an opinion. Then I asked if there was a limit to the number of autologous transplants, and he mentioned he has heard of people having 4 and 6 transplants, although I'm not certain they were all autologous transplants.
Best wishes
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
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