[ping]

Albumin, beta-2 microglobulin & prognosis questions

by ping on Sun Apr 12, 2015 2:10 pm

My guess is that some of the readers might be able to give me some insight into the following two questions.

    A.    The present standard prognosis system (if one does not take into consideration im­por­tant chromosomal aspects) is the "International Staging System" (ISS) which is based on beta-2 microglobulin and albumin.

1. Given your beta-2 microglobulin and albumin levels at diagnosis, how should these number evolve become during treatment?
2. If they reach normal levels during treatment, how does that affect prognosis? Is it the case that the initial values still have their prognosis value independent of the evolution of these numbers during treatment?

    B.    I had understood that the amount of albumin and the amount of the M-component are negatively correlated.

1. To what extent is this true?
2. My M-component went down from 3 g/L to 2 g/l but at the same time albumin went also from 39 to 31 showing perhaps the negative correlation is not so simple. How does one interpret an M-component going down but with albumin moving from within normal limits to below normal limits? (In my case the 3 g/L to 2 g/l might of course be too small to be of significance.)

Thanks for any input. Ping

[blair77]

Re: Albumin, beta-2 microglobulin & prognosis questions

by blair77 on Mon Apr 13, 2015 1:08 am

I don't believe there is a true correlation between albumin and your M-spike. Your M spike going down is a positive thing no matter if your albumin goes up or not. Also, albumin level in reference to prognosis only has significance at diagnosis.

[JimNY]

Re: Albumin, beta-2 microglobulin & prognosis questions

by JimNY on Mon Apr 13, 2015 3:28 pm

Hi Ping,

Blair has given you some good feedback already. I would just add that, if you search the forum discussions for threads about "albumin", "microglobulin", or "beta", you'll find a number of discussions, the primary thrust of which is that both the markers you mentioned are primarily useful for assessing the stage of multiple myeloma at diagnosis. After diagnosis, you really want to focus on your M-spike and free light chain levels when it comes to tracking your disease and how it is responding to treatment.

There also are other lab results that can be useful for checking on signs of the disease having an impact on the body, like hemoglobin levels, creatinine levels, and calcium levels. Those are particularly helpful to watch, in my opinion, while you are in remission, or if you are smoldering, to see if any signs are developing of the disease rearing its head.

Also, while you're on treatment, it can be important to check things like your white blood cell count and neutrophil levels.

I would add that staging systems such as the ISS were only partly designed, as far as I understand it, to provide prognostic information. The systems were designed more to give a sense of how advanced / extensive the disease is at diagnosis, rather than how difficult the disease is to treat.

These days, much more emphasis is placed on chromosomal abnormalities when assessing how well, or how poorly, myeloma is likely to respond to treatment.

[Multibilly]

Re: Albumin, beta-2 microglobulin & prognosis questions

by Multibilly on Mon Apr 13, 2015 4:18 pm

Ping:

These comments from Dr. Libby in a previous forum thread ("Beta 2 microglobulin", started March 8, 2015) reinforce what Blair and Jim are saying:

In general, there is no reason to get the beta-2 microglobulin test after the initial diagnosis of multiple myeloma is made. The only time it has significant value is at diagnosis to de­ter­mine the patient's stage. As you may know, the International Staging System for myeloma (ISS) uses two blood measurements – the albumin level, and the beta-2 microglobulin level – to de­ter­mine a patient's stage at diagnosis.

After determining a patient's stage at diagnosis, the beta-2 microglobulin is really not very use­ful. I generally do not repeat it after making the initial diagnosis of myeloma. Some research studies may require it, and many physicians do obtain it, but, from my perspective, the really useful tests that tell us how a patient's myeloma is doing are your SPEP, serum free light chains, and UPEP."