Hello all,
I have been having my blood work done at the same location since I was first diagnosed almost 5 years ago. Lately my blood work is showing results that don't align with what a recent bone marrow biopsy indicates. The bone marrow biopsy comments say that the results are not consistent with the findings of increased M protein from blood tests and reflect a blood sampling issue.
Does anyone know what would cause the bone marrow biopsy and blood tests basically not to show results that agree with each other?
All my CBC and CMP labs are almost perfect, with just my WBC slightly under reference. I am thinking of asking my oncologist to have me try another pathology service.
My last blood work was as follows:
Total protein 6.2 (6.4-8.3 )
IgA 147 (73-347 )
IgG 756 (657-1610 )
Iga 56 (46-304 )
Free Kappa ser. 16.7 (3.3-19.4 )
Free Lambda ser 10.5 (5.7-26.3 )
Kap/Lam Ratio 1.59 (0.26-1.65 )
IFE comments, Gamma globulin protein spike are present with an IgG / lambda, two faint IgM / kappa and two lambda with no heavy chain correlations. Monoclonal paraproteins were identified.
SPEP comments, Gamma globulin protein spike is still present and comprises 3.6% of total protein. A second gamma globulin protein spike is also present and comprises 1.9% of total protein.
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5 posts
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Blood test results & bone marrow biopsy disagree: why?
Castaway,
From what I am seeing, your serum free light chain assay results and bone marrow biopsy results are in agreement. The free light chain assay shows normal readings and is thus consistent with a finding of no M-spike per the bone marrow biopsy. These look like you are doing great!
(I have found that the serum free light chain assay is more sensitive than the standard serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE).)
From what I am seeing, your serum free light chain assay results and bone marrow biopsy results are in agreement. The free light chain assay shows normal readings and is thus consistent with a finding of no M-spike per the bone marrow biopsy. These look like you are doing great!
(I have found that the serum free light chain assay is more sensitive than the standard serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE).)
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Blood test results & bone marrow biopsy disagree: why?
Thanks Ron.
One of the concerns is the spikes being IgG lambda, two faint IgM kappa plus two lambda with no heavy chain correlations. At diagnosis almost 5 years ago, I was IgA. Months after transplant, my labs were showing IgG. My last two labs are like I posted. I understand that there can be isotype switching. And that could have been the reason it switched from IgA to IgG, but I am puzzled over the addition of IgM kappa plus the two lambda with no heavy chain on my recent labs. Looks like I have multiple, multiple myelomas.
Thank you, George
One of the concerns is the spikes being IgG lambda, two faint IgM kappa plus two lambda with no heavy chain correlations. At diagnosis almost 5 years ago, I was IgA. Months after transplant, my labs were showing IgG. My last two labs are like I posted. I understand that there can be isotype switching. And that could have been the reason it switched from IgA to IgG, but I am puzzled over the addition of IgM kappa plus the two lambda with no heavy chain on my recent labs. Looks like I have multiple, multiple myelomas.
Thank you, George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: Blood test results & bone marrow biopsy disagree: why?
A secondary M-spike may be an indicator that you have had a good response and predicts better overall survival. See the articles mentioned in this forum thread,
"Secondary MGUS - articles" (started April 10, 2016)
including this one:
D Zou et al, "Secondary Monoclonal Gammopathy of Undetermined Significance Is Frequently Associated with High Response Rate and Superior Survival in Patients with Plasma Cell Dyscrasias," Biology of Blood and Marrow Transplantation, March 2014 (full text of article)
"Secondary MGUS - articles" (started April 10, 2016)
including this one:
D Zou et al, "Secondary Monoclonal Gammopathy of Undetermined Significance Is Frequently Associated with High Response Rate and Superior Survival in Patients with Plasma Cell Dyscrasias," Biology of Blood and Marrow Transplantation, March 2014 (full text of article)
Re: Blood test results & bone marrow biopsy disagree: why?
Molly,
Thank you so much for the information. I see that Goldmine848 has several that I will read. I did read the full article you sent on secondary monoclonal gammopathy. I had a call into my transplant doctor anyway. And just waiting for his call back. I will read all the articles and bring this up with him. I will also print one of the articles for my local oncologist to see what he thinks at my next appointment.
Thank You, George
Thank you so much for the information. I see that Goldmine848 has several that I will read. I did read the full article you sent on secondary monoclonal gammopathy. I had a call into my transplant doctor anyway. And just waiting for his call back. I will read all the articles and bring this up with him. I will also print one of the articles for my local oncologist to see what he thinks at my next appointment.
Thank You, George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
5 posts
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