Is it possible for blood test results not be to be indicative of the bone marrow?
Over the last six months, I believe thru correct nutrition, the paraproteins in my blood have dropped amazingly. I thought I was doing good.
Oncologist advises she doesn't trust my blood because it is not indicative of the plasma in the bone marrow, which has double over last six months.
Is this unusual?
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Ailsa - Name: Ailsa
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: May 2014
- Age at diagnosis: 53
Re: Can blood test results contradict BMB results?
A small number of people with myeloma have what's called, nonsecretory myeloma. In this type of myeloma, there is no evidence of the cancer in the blood. It has to be followed by bone marrow biopsies and by PET/CT scans on a regular basis. This is a difficult form of myeloma to follow because there is no evidence in the blood.
Ask your oncologist for more details about your type of myeloma.
Nancy in Phila
Ask your oncologist for more details about your type of myeloma.
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: Can blood test results contradict BMB results?
Hi Ailsa,
Like Nancy, I initially thought that you might be nonsecretory. However, you mentioned that you've had an M-spike in the past, and it has dropped. If I recall correctly, your diagnosis initially was IgA lambda smoldering myeloma, but perhaps it has changed to multiple myeloma? I say all of this based on your postings in this thread:
https://myelomabeacon.org/forum/paraproteins-m-spike-drop-without-chemo-t4212.html
If you've had an M-spike with smoldering myeloma, or borderline smoldering multiple myeloma / multiple myeloma, I somehow doubt that your disease is suddenly becoming non-secretory. So I'm not sure that's the explanation.
Instead, I wonder if the explanation is what Multibilly mentioned in the earlier discussion, which is that M-spikes for people with IgA myeloma can be unreliable. For example, what has happened to your IgA levels during the time that your M-spike has been dropping?
I do agree with Nancy that it would be worth getting a better explanation from your doctor as to why exactly she thinks your M-spike is an unreliable measure of your disease.
Hope this helps a bit.
Like Nancy, I initially thought that you might be nonsecretory. However, you mentioned that you've had an M-spike in the past, and it has dropped. If I recall correctly, your diagnosis initially was IgA lambda smoldering myeloma, but perhaps it has changed to multiple myeloma? I say all of this based on your postings in this thread:
https://myelomabeacon.org/forum/paraproteins-m-spike-drop-without-chemo-t4212.html
If you've had an M-spike with smoldering myeloma, or borderline smoldering multiple myeloma / multiple myeloma, I somehow doubt that your disease is suddenly becoming non-secretory. So I'm not sure that's the explanation.
Instead, I wonder if the explanation is what Multibilly mentioned in the earlier discussion, which is that M-spikes for people with IgA myeloma can be unreliable. For example, what has happened to your IgA levels during the time that your M-spike has been dropping?
I do agree with Nancy that it would be worth getting a better explanation from your doctor as to why exactly she thinks your M-spike is an unreliable measure of your disease.
Hope this helps a bit.
Re: Can blood test results contradict BMB results?
Many thanks for the informative responses. Yes, it did develop to multiple myeloma (anaemia, low platelets, etc.). Weekly treatment started (bortezomib [Velcade], steroids and Zometa), along with a few blood transfusions.
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Ailsa - Name: Ailsa
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: May 2014
- Age at diagnosis: 53
Re: Can blood test results contradict BMB results?
Hi Ailsa,
Both Nancy and Cheryl are correct.
1) In some patients there can be a lot of plasma cells in the bone marrow and no or limited protein detected in the blood. This is called nonsecretory (no protein detected despite lots of plasma cells) or oligosecretory (there is a little bit of protein detected). If this is the case and you had a lot of plasma cells in the bone marrow to start but only a tiny M-spike, with therapy the M-spike can go down but there are still lots of plasma cells in the bone marrow.
OR
2) IgA M-proteins are difficult to detect on the SPEP. Such that in some patients with IgA disease the M-protein is difficult to detect on the SPEP despite the disease continue to be present.
So indeed I agree that a conversation with your doctor about what is going on with you and your disease that makes the blood and the bone morrow appear to contradict one another, is warranted.
Hope that helps!
Both Nancy and Cheryl are correct.
1) In some patients there can be a lot of plasma cells in the bone marrow and no or limited protein detected in the blood. This is called nonsecretory (no protein detected despite lots of plasma cells) or oligosecretory (there is a little bit of protein detected). If this is the case and you had a lot of plasma cells in the bone marrow to start but only a tiny M-spike, with therapy the M-spike can go down but there are still lots of plasma cells in the bone marrow.
OR
2) IgA M-proteins are difficult to detect on the SPEP. Such that in some patients with IgA disease the M-protein is difficult to detect on the SPEP despite the disease continue to be present.
So indeed I agree that a conversation with your doctor about what is going on with you and your disease that makes the blood and the bone morrow appear to contradict one another, is warranted.
Hope that helps!
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Dr. Heather Landau - Name: Heather Landau, M.D.
Beacon Medical Advisor
Re: Can blood test results contradict BMB results?
In addition to the two points Dr. Landau wisely listed above, I would like to add a third. Bone marrow biopsies sample a small area of the ischial bone marrow, which may not be representative of the overall distribution of malignant plasma cells in the body. Neither are SPEP or UPEP tests for M protein, or serum free light chain tests.
We all have several, if not multiple, mutated plasma cell lines, which may all vary in their secretory potential and their propensity for involvement of the bone marrow. This is especially true with extramedullary disease, and the presence of plasmacytomas.
I believe the best way to monitor refractory multiple myeloma patients in these circumstances is the use of serial PET/CT scans. These are much more accurate for the evaluation of active disease than the use of skeletal X ray surveys, or even MRI's.
We all have several, if not multiple, mutated plasma cell lines, which may all vary in their secretory potential and their propensity for involvement of the bone marrow. This is especially true with extramedullary disease, and the presence of plasmacytomas.
I believe the best way to monitor refractory multiple myeloma patients in these circumstances is the use of serial PET/CT scans. These are much more accurate for the evaluation of active disease than the use of skeletal X ray surveys, or even MRI's.
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Jan Stafl - Name: Jan Stafl MD
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: July 2011
- Age at diagnosis: 54
6 posts
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