Hello everyone! I have been a member of this group for a while due to my brother having multiple myeloma, but now I'm here to ask questions regarding myself.
I have been told that I have MGUS with a high IgA (double the normal high value), a Beta 2 peak (?) and slightly increased lambda light chains (this test was called free light chains but not "Freelite" - I do not live in the USA). The K/L ratio was a little low but still within the limits of normal.
Because my brother has end-stage multiple myeloma, it was decided to do a bone marrow aspiration. The oncologist (a multiple myeloma specialist) told me he was going to do a test called flow cytometry and something with deletions and translocations (?).
Anyway, I had the aspiration done and waited 3 weeks for results, which the doctor emailed to me with no comment. To me the report is all Greek. It is a list of letters and numbers, mostly all starting with CD, a positive % number, and a number after that called "population lymphocytes.
My M-spike BTW is 0.8 - nothing serious. Also, there is nothing about deletions or translocations on this report.
Can anyone tell me how to interpret all the CD #s? When I asked the doctor, he said "don't worry, see you in a year." I'd like to understand more.
Thanks in advance!
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Lillyput189 - Who do you know with myeloma?: Self
- When were you/they diagnosed?: MGUS 2011, multiple myeloma 2014
- Age at diagnosis: 54
Re: Making sense of a bone marrow aspiration report
There are a couple of important takeaways from a bone marrow biopsy (BMB) that I'd suggest you focus on, rather than try to sort thorough all the flow cytometry results (which can be complex ).
There should be a conclusion or diagnosis section at the end of the pathology section of the report, where it will summarize your plasma cell population. It will be a percentage. If you are indeed MGUS, it will be a figure less than 10%. It might be called out as as "Lambda Plasma Cell Population at x%" or something like that.
There should also be a FISH section in the report (this is the section of the report that includes those "deletions and translocations" that you talked about).
The FISH section will have one column labeled as "Probes" (or something like that) and will have entries like "17p- del 17p..", "AMP1q21" under it. Next to that column they should have a "Results" (or something like that) column, where it will say if the results were normal or not. They will probably also include a percentage range column next to the results column. This table summarizes your "cytogenetics". If the result for a given probe was listed as not normal, you may have that mutation. There should also be a section under this table where the pathologist will comment on any abnormal (or favorable) mutations. Note that you very well may not have any mutations.
Being MGUS, I wouldn't worry about the flow cytometry results (this is the section that has all the "CD" entries).
You just basically want to know what your plasma cell population % is and if you have any unfavorable genetic mutations.
Hope this helps.
There should be a conclusion or diagnosis section at the end of the pathology section of the report, where it will summarize your plasma cell population. It will be a percentage. If you are indeed MGUS, it will be a figure less than 10%. It might be called out as as "Lambda Plasma Cell Population at x%" or something like that.
There should also be a FISH section in the report (this is the section of the report that includes those "deletions and translocations" that you talked about).
The FISH section will have one column labeled as "Probes" (or something like that) and will have entries like "17p- del 17p..", "AMP1q21" under it. Next to that column they should have a "Results" (or something like that) column, where it will say if the results were normal or not. They will probably also include a percentage range column next to the results column. This table summarizes your "cytogenetics". If the result for a given probe was listed as not normal, you may have that mutation. There should also be a section under this table where the pathologist will comment on any abnormal (or favorable) mutations. Note that you very well may not have any mutations.
Being MGUS, I wouldn't worry about the flow cytometry results (this is the section that has all the "CD" entries).
You just basically want to know what your plasma cell population % is and if you have any unfavorable genetic mutations.
Hope this helps.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Making sense of a bone marrow aspiration report
Thank you Multibilly for your reply. My results say only:
Cell/mm3: 137000
% lymphocytes - 17.6
% monocytes - 5.4
% myeloid cells - 55.2
% erythroblasts: 17.7
Then follows the long list of CD #s.
The comment is only "the results are expressed in percentage of positive related to the total cellular population."
There is no FISH section.
I'm totally confused & the doctor is of no help to me. Your thoughts?
As ever, thank you in advance.
Cell/mm3: 137000
% lymphocytes - 17.6
% monocytes - 5.4
% myeloid cells - 55.2
% erythroblasts: 17.7
Then follows the long list of CD #s.
The comment is only "the results are expressed in percentage of positive related to the total cellular population."
There is no FISH section.
I'm totally confused & the doctor is of no help to me. Your thoughts?
As ever, thank you in advance.
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Lillyput189 - Who do you know with myeloma?: Self
- When were you/they diagnosed?: MGUS 2011, multiple myeloma 2014
- Age at diagnosis: 54
Re: Making sense of a bone marrow aspiration report
So, maybe they didn't run a FISH since you are only MGUS, but you did say that your doctor mentioned testing for "deletions and translocations", so this is where you would find it. Maybe they called that section "Fluorescence in situ hybridization" (although you can get some information on chromosomal abnormalities in the karyotyping/cytogenetics section of the report)?
The figures you stated here (Cell/mm3: 137000, etc) are the results of the microscopic inspection of your white blood cells (I'm not qualified to comment on these, but these are not the numbers for determining your total plasma cell population).
Try looking for a section of the report that talks about "staining". It may talk about the plasma cell percentage there. They specifically may have used a stain to identify those cells that have a marker on them known as CD138. CD138 is typically associated with plasma cells (both normal and cancerous). After applying the stain to the specimen, they then just look at your specimen under a microscope and then count those cells that are flagged with the stain and compare that to the total number of cells they see to come up with a percentage.
But, rather than try to decipher this all yourself, you really should be able to just call up your doctor and ask him this question. It's a very reasonable question, after all. Just ask him what was the plasma cell percentage result of the bone marrow biopsy that is used for myeloma staging purposes? And, do you have any unfavorable mutations?
If your doctor is uncooperative, the report should be signed by the pathologist who did the analysis. You could always call that lab (which I've done a couple of times before ... I've found these lab professionals to be very helpful). Or, you could ask another doctor to help you ... or consider getting another doctor if he isn't going to help you with the basics.
The last couple of sections in this link provides a real basic summary of what you should be able to get out of the report:
http://myeloma.org/pdfs/IMF-U-TestResults-2011_f1web.pdf
The figures you stated here (Cell/mm3: 137000, etc) are the results of the microscopic inspection of your white blood cells (I'm not qualified to comment on these, but these are not the numbers for determining your total plasma cell population).
Try looking for a section of the report that talks about "staining". It may talk about the plasma cell percentage there. They specifically may have used a stain to identify those cells that have a marker on them known as CD138. CD138 is typically associated with plasma cells (both normal and cancerous). After applying the stain to the specimen, they then just look at your specimen under a microscope and then count those cells that are flagged with the stain and compare that to the total number of cells they see to come up with a percentage.
But, rather than try to decipher this all yourself, you really should be able to just call up your doctor and ask him this question. It's a very reasonable question, after all. Just ask him what was the plasma cell percentage result of the bone marrow biopsy that is used for myeloma staging purposes? And, do you have any unfavorable mutations?
If your doctor is uncooperative, the report should be signed by the pathologist who did the analysis. You could always call that lab (which I've done a couple of times before ... I've found these lab professionals to be very helpful). Or, you could ask another doctor to help you ... or consider getting another doctor if he isn't going to help you with the basics.
The last couple of sections in this link provides a real basic summary of what you should be able to get out of the report:
http://myeloma.org/pdfs/IMF-U-TestResults-2011_f1web.pdf
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Making sense of a bone marrow aspiration report
"They will probably also include a percentage range column next to the results column"
Multibilly what do these tell a person?
Multibilly what do these tell a person?
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Wayne K - Name: Wayne
- Who do you know with myeloma?: Myself, my sister who passed in '95
- When were you/they diagnosed?: 03/09
- Age at diagnosis: 70
Re: Making sense of a bone marrow aspiration report
Wayne,
So, specific FISH studies are set up for specific diseases like multiple myeloma. The lab instrument is configured with a set of probes, where each probe looks for a given mutation (i.e. 17p deletion, etc) that has been determined to be of interest for a given disease.
Each probe has its own standard reference range (just like you have reference ranges for all your other lab values). If a given FISH probe detects anything above the normal reference range for that probe, then it is determined that you have that mutation.
So, as an example, my FISH results say that the normal reference range for a 1q21 gain probe is 0-3.6%. My actual measurement was 1.5%. So, this is considered normal and I'm not considered to have the 1q21 gain even though some percentage of my plasma cells showed this gain on the test.
You are now probably going to ask why wouldn't anything > 0 be considered abnormal? This is because the FISH test itself isn't perfect and will produce "false positives" due to many different reasons. The reference range for a given probe is basically what is considered to be a normal range of false positives for that given probe.
So, specific FISH studies are set up for specific diseases like multiple myeloma. The lab instrument is configured with a set of probes, where each probe looks for a given mutation (i.e. 17p deletion, etc) that has been determined to be of interest for a given disease.
Each probe has its own standard reference range (just like you have reference ranges for all your other lab values). If a given FISH probe detects anything above the normal reference range for that probe, then it is determined that you have that mutation.
So, as an example, my FISH results say that the normal reference range for a 1q21 gain probe is 0-3.6%. My actual measurement was 1.5%. So, this is considered normal and I'm not considered to have the 1q21 gain even though some percentage of my plasma cells showed this gain on the test.
You are now probably going to ask why wouldn't anything > 0 be considered abnormal? This is because the FISH test itself isn't perfect and will produce "false positives" due to many different reasons. The reference range for a given probe is basically what is considered to be a normal range of false positives for that given probe.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Making sense of a bone marrow aspiration report
I was a little confused, but I see now that they didn't give a percentage for the results, but listed "normal". I couldn't quite understand the range being given without a result to match.
Thanks for the summary.
Thanks for the summary.
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Wayne K - Name: Wayne
- Who do you know with myeloma?: Myself, my sister who passed in '95
- When were you/they diagnosed?: 03/09
- Age at diagnosis: 70
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