Just got back the results of the my father's bone marrow biopsy and his blood tests.
Bone marrow biopsy results:
Plasma cells are 3 percent. Erythropoiesis is active and predominantly normoblastic in type. Iron stores are adequate and no pathological sideroboblasts are seen. Granulaopoiesis shows myeloid precursors with orderly maturation to the segmented neutrophil stage. Megakaryocytes are present.
(Not sure what all this means but the 3 percent sounds really good.)
Results of blood tests:
Urine creatinine: 14.3
Protein: 0.22
Kappa free light chains: 12.9
Lambda free light chains: 31.5
Kappa / lambda FLC ration: 0.41
I hope someone can help me interpret this stuff. Any help on this would be greatly appreciated.
Thanks!
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Bone marrow biopsy and blood test results back!
Last edited by Pootren on Thu Aug 14, 2014 11:21 pm, edited 1 time in total.
Re: Bone marrow biopsy and blood test results back!
Hi Pootren,
Glad you got your father's test results back. We hope he's adjusting to his treatment.
When you get a chance, could you add units to all the test results you provide, such as "g/L", etc.? They can be different from country to country (and from laboratory to laboratory).
Reference (normal) ranges would be helpful, as well, if they've been included in the lab results. Again, those can vary a bit from lab to lab.
Finally, because not everyone is familiar with your father's case, you may want to make an additional posting just explaining that your father was newly diagnosed, the results of his x-rays / MRIs / etc. were this and that, etc. It would provide some context for these results and perhaps allow people to give you more helpful advice on what the results mean.
Thanks!
Glad you got your father's test results back. We hope he's adjusting to his treatment.
When you get a chance, could you add units to all the test results you provide, such as "g/L", etc.? They can be different from country to country (and from laboratory to laboratory).
Reference (normal) ranges would be helpful, as well, if they've been included in the lab results. Again, those can vary a bit from lab to lab.
Finally, because not everyone is familiar with your father's case, you may want to make an additional posting just explaining that your father was newly diagnosed, the results of his x-rays / MRIs / etc. were this and that, etc. It would provide some context for these results and perhaps allow people to give you more helpful advice on what the results mean.
Thanks!
Re: Bone marrow biopsy and blood test results back!
Here is a summary of what's been happening:
My father (68 years old) has 4 lesions: skull, 2 in spinal vertebrae, and 1 in shoulder. He fractured his hip a year ago. He has no pain except now in his skull where the lesion is located.
His doctor keeps referring to his case as 'unusual'. He has started on bone strengthening infusions, steroids and will be starting chemo right away.
Here are the numbers again:
Plasma cells are approximately 3 percent.
Free light chains
Lambda free light chains 31.5 mg/l
Kappa free light chains 12.9
Kappa/lambda FLC ration: 0.41
Only lambda is out of range, which normal is 3.3-19.4
Serum proteins are all normal except Beta 2 globulin which is 7 g/l normal 2-5
Protein monoclonal <1 g/l but it also says 'trace monoclonal iga lambda band in beta gamma region " this is 'flagged as well it is <1 in gamma zone and has an "H" in the flag region
Urine protein 24 hr 0.22 normal is less than 0.15 rest of urine normal.
Hope this helps! Like I said, the doctor said he was 'on the line' and 'unusual'.
I appreciate your help
My father (68 years old) has 4 lesions: skull, 2 in spinal vertebrae, and 1 in shoulder. He fractured his hip a year ago. He has no pain except now in his skull where the lesion is located.
His doctor keeps referring to his case as 'unusual'. He has started on bone strengthening infusions, steroids and will be starting chemo right away.
Here are the numbers again:
Plasma cells are approximately 3 percent.
Free light chains
Lambda free light chains 31.5 mg/l
Kappa free light chains 12.9
Kappa/lambda FLC ration: 0.41
Only lambda is out of range, which normal is 3.3-19.4
Serum proteins are all normal except Beta 2 globulin which is 7 g/l normal 2-5
Protein monoclonal <1 g/l but it also says 'trace monoclonal iga lambda band in beta gamma region " this is 'flagged as well it is <1 in gamma zone and has an "H" in the flag region
Urine protein 24 hr 0.22 normal is less than 0.15 rest of urine normal.
Hope this helps! Like I said, the doctor said he was 'on the line' and 'unusual'.
I appreciate your help
Re: Bone marrow biopsy and blood test results back!
Your father's case is only a bit odd. I have several patients where the random bone marrow biopsy looks quite normal but lytic lesions are present in multiple areas. I do biopsy one of the lesions just to make sure that it is myeloma and not something else causing the lytic lesions. There are benign and other malignant causes of lytic lesions.
Again though, it is not unheard of for the marrow to look normal and the bones to be involved with myeloma lesions.
Again though, it is not unheard of for the marrow to look normal and the bones to be involved with myeloma lesions.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: Bone marrow biopsy and blood test results back!
He did have a biopsy on the lesion and it was myeloma. Just need help figuring out the results and what type of myeloma it is.
Re: Bone marrow biopsy and blood test results back!
Hi Pootren,
First off, I'm not a doctor. So, please double check this with a doctor. There are a few things to consider here:
As Dr. Valent pointed out, the test results are a bit odd. While your dad has a slightly elevated lambda FLC value, he has a low M-Spike (< 1 g/dL, which in the USA, we would label as < 0.1 g/dL; this is quite a low M-Spike for a symtompatic patient). And he has a low plasma percentage (3%). Again, this is quite low and is the kind of figure you see in patients without multiple myeloma.
Note also that the plasma percentage reading from a bone marrow biopsy can vary quite a bit, depending on whether the biopsy needle hits a pocket of disease or not (the disease is not uniformly spread throughout one's bone marrow).
But, your Dad clearly has multiple lytic lesions (which have been verified as being mm-related by a biopsy), so he needs treatment.
Are any of his individual immunoglobulin levels elevated (IgM, IgA, etc)? It looks like the test results indicated that the M-Protein may be IgA lambda type, so the IgA may be elevated?
Given that he is symptomatic and has almost no M-Spike but has an elevated lambda free light chain, this may be a "low-secreting" or light-chain-restricted version of myeloma (which occurs in about 20% of patients). This has implications for how you track the disease in the future.
IgA-type myeloma (if that is what he has) is also a bit harder to track, especially with the SPEP test (Serum Protein Electrophoresis, which is the test that told you about your Dad's monoclonal protein being less than 1 g/L).
I don't know if you have access to it yet in Canada, but there is a brand new test out called the Hevylite assay which is useful for tracking IgA-type myeloma. But if he has a low-secreting version of the disease, the Freelite assay (which is the test that told you about the lambda and kappa values), may be the primary test that will be used to track the disease.
In any case, I would suggest talking more with the specialist about all this. I don't think your dad's type of treatment plan is really going to change much based on this information, nor will it change based on the stage of his multiple myeloma (again, verify all this with the specialist). But there could be implications for how you would track the disease going forward.
Hope this helps a little bit.
First off, I'm not a doctor. So, please double check this with a doctor. There are a few things to consider here:
As Dr. Valent pointed out, the test results are a bit odd. While your dad has a slightly elevated lambda FLC value, he has a low M-Spike (< 1 g/dL, which in the USA, we would label as < 0.1 g/dL; this is quite a low M-Spike for a symtompatic patient). And he has a low plasma percentage (3%). Again, this is quite low and is the kind of figure you see in patients without multiple myeloma.
Note also that the plasma percentage reading from a bone marrow biopsy can vary quite a bit, depending on whether the biopsy needle hits a pocket of disease or not (the disease is not uniformly spread throughout one's bone marrow).
But, your Dad clearly has multiple lytic lesions (which have been verified as being mm-related by a biopsy), so he needs treatment.
Are any of his individual immunoglobulin levels elevated (IgM, IgA, etc)? It looks like the test results indicated that the M-Protein may be IgA lambda type, so the IgA may be elevated?
Given that he is symptomatic and has almost no M-Spike but has an elevated lambda free light chain, this may be a "low-secreting" or light-chain-restricted version of myeloma (which occurs in about 20% of patients). This has implications for how you track the disease in the future.
IgA-type myeloma (if that is what he has) is also a bit harder to track, especially with the SPEP test (Serum Protein Electrophoresis, which is the test that told you about your Dad's monoclonal protein being less than 1 g/L).
I don't know if you have access to it yet in Canada, but there is a brand new test out called the Hevylite assay which is useful for tracking IgA-type myeloma. But if he has a low-secreting version of the disease, the Freelite assay (which is the test that told you about the lambda and kappa values), may be the primary test that will be used to track the disease.
In any case, I would suggest talking more with the specialist about all this. I don't think your dad's type of treatment plan is really going to change much based on this information, nor will it change based on the stage of his multiple myeloma (again, verify all this with the specialist). But there could be implications for how you would track the disease going forward.
Hope this helps a little bit.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Bone marrow biopsy and blood test results back!
Thanks so much. We will definitely consult with a specialist. Oncologist already mentioned seeing someone a bit down the road. It's all pretty overwhelming right now. I guess we see how he responds to chemo.
Sounds like IgA to me too from looking at results. Does that mean it could be worse than it looks? I read IgA is more aggressive. Are number usually low and hard to see with this type?
Sounds like IgA to me too from looking at results. Does that mean it could be worse than it looks? I read IgA is more aggressive. Are number usually low and hard to see with this type?
Re: Bone marrow biopsy and blood test results back!
Hi Pootren,
This recent thread on IgA-type multiple myeloma may help you better understand your question with regard to aggressiveness of IgA-type myeloma (again, your doc needs to verify if it is indeed IgA lambda-type multiple myeloma that you are dealing with here).
"Is IgA multiple myeloma more aggressive?", Beacon forum discussion started August 9, 2014.
IgA spikes can be harder for an SPEP to measure because other proteins in one's blood can and do hang out in the same region of the electrophoresis graph that the IgA spike would be in. In other words, the spikes (or signatures) from other proteins can essentially mask or hide the pathologist's view of the IgA-spike when he or she is looking at the SPEP graph.
There are some other challenges with measuring IgA spikes with an SPEP, but I "believe" the above description is the primary challenge.
This recent thread on IgA-type multiple myeloma may help you better understand your question with regard to aggressiveness of IgA-type myeloma (again, your doc needs to verify if it is indeed IgA lambda-type multiple myeloma that you are dealing with here).
"Is IgA multiple myeloma more aggressive?", Beacon forum discussion started August 9, 2014.
IgA spikes can be harder for an SPEP to measure because other proteins in one's blood can and do hang out in the same region of the electrophoresis graph that the IgA spike would be in. In other words, the spikes (or signatures) from other proteins can essentially mask or hide the pathologist's view of the IgA-spike when he or she is looking at the SPEP graph.
There are some other challenges with measuring IgA spikes with an SPEP, but I "believe" the above description is the primary challenge.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Bone marrow biopsy and blood test results back!
Thanks for your reply Dr Valent. With the patients that have this type of reading, was their prognosis different? How are they staged? I have no idea if he is low or high risk based on the numbers above. Any info greatly appreciated
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