My smoldering diagnosis is just a few days old, but I am surprised. I'm just getting up to speed on the numbers, but we didn't think my other numbers seemed too far along, until the bone marrow biopsy results.
These were my immunoglobulin results:
IgA 1468 mg/dL
IgM 44 mg/dL
IgG 671 mg/dL
My M-spike is 1.72 g/dL (17.2 g/l), IgA kappa.
Free Kappa - 3.71 mg/dL
Free Lambda - 0.53 mg/dL
Kappa/Lambda Ratio: 7.00.
So to me, those numbers didn't seem as high as others that I have seen on this forum, then we got this:
Aspriate: 17%
Bone marrow: 30-40%
And something with the flow cytometry being 97% (this seemed bad, high risk?)
I am still waiting on complete FISH.
Are the bone marrow biopsy results out of step with the other results and, if so, what does that mean?
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Eileenk - Name: Eileen
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Smoldering, September 2017
- Age at diagnosis: 49
Re: Do my bone marrow biopsy results fit with other results?
Hi Eileen,
First off, myeloma can present in many different ways. You can have bone marrow biopsy results that are completely in lockstep with the serum lab test results. Alternatively, you can have non-secretory myeloma where the disease only reveals itself in the bone marrow and the serum lab tests are normal. Or, you can have oligosecretetory myeloma where the serum lab results only partially reflect the disease burden revealed from the bone marrow biopsy (which seems closer to your situation). And you can have every combination inbetween.
A couple of more notes on your results:
In general, the IMWG recommends that you take the higher of the aspirate and marrow plasma cell percentages for diagnostic purposes. So, you would use 30-40% for your plasma cell percentage figure.
For reasons I won't go into here, IgA m-spikes tend to often be overstated. In your situation, that clearly seems to be the case. I say this because your IgA m-spike is 1.72 g/dL, while your total IgA figure is 1468 mg/dL (1.468 g/dL) Since your total IgA = normal IgA + IgA m-spike, your IgA m-spike level is clearly overstated (which is good news). Your true IgA m-spike is likely something closer to 1 g/dL. I might suggest talking to your oncologist about using the new "Hevylite" test to better track your monoclonal IgA levels.
Lastly, you really need to provide some context on the 97% figure in your flow ctyometry results for us to comment. Flow cytometry measures the percentages of cells that have one or more specific antigens (protein markers such as CD-138) on the cell's surface. Typically, flow-cytometry tests will be set up to look for several of these markers (4-color, 5-color flow cytometry, etc) and several different measurements will be reported. One of these markers being clocked at 97% doesn't necessarily mean something especially bad is going on or that you are at "high risk". In fact, flow cytometry results aren't used to determine one's progression risk factor.
First off, myeloma can present in many different ways. You can have bone marrow biopsy results that are completely in lockstep with the serum lab test results. Alternatively, you can have non-secretory myeloma where the disease only reveals itself in the bone marrow and the serum lab tests are normal. Or, you can have oligosecretetory myeloma where the serum lab results only partially reflect the disease burden revealed from the bone marrow biopsy (which seems closer to your situation). And you can have every combination inbetween.
A couple of more notes on your results:
In general, the IMWG recommends that you take the higher of the aspirate and marrow plasma cell percentages for diagnostic purposes. So, you would use 30-40% for your plasma cell percentage figure.
For reasons I won't go into here, IgA m-spikes tend to often be overstated. In your situation, that clearly seems to be the case. I say this because your IgA m-spike is 1.72 g/dL, while your total IgA figure is 1468 mg/dL (1.468 g/dL) Since your total IgA = normal IgA + IgA m-spike, your IgA m-spike level is clearly overstated (which is good news). Your true IgA m-spike is likely something closer to 1 g/dL. I might suggest talking to your oncologist about using the new "Hevylite" test to better track your monoclonal IgA levels.
Lastly, you really need to provide some context on the 97% figure in your flow ctyometry results for us to comment. Flow cytometry measures the percentages of cells that have one or more specific antigens (protein markers such as CD-138) on the cell's surface. Typically, flow-cytometry tests will be set up to look for several of these markers (4-color, 5-color flow cytometry, etc) and several different measurements will be reported. One of these markers being clocked at 97% doesn't necessarily mean something especially bad is going on or that you are at "high risk". In fact, flow cytometry results aren't used to determine one's progression risk factor.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Do my bone marrow biopsy results fit with other results?
Hi Multibilly,
I got my flow cytometry report and hematopathology a week or two ago:
Bone marrow, left posterior iliac crest, biopsy and aspirate smears:
30-40% involvement by CD138 immunohistochemistry, ranging from 80-20% with uneven distribution
17% involvement by aspriate differential
3.2% involvement by 10-color flow cytometry
Cellular marrow with trilineage maturing hematopoiesis
BCMA shows 3+ Golgi and membranous staining
Separate section:
"No abnormal mature B-cell population detected"
"Flow cytometry reveals abnormal plasma cell population expression of CD19 (absent), CD27 (absent), CD45 (absent), CD56 (bright), CD81 (absent) and monoclonal kappa cytoplasmic light chain restriction; with normal expression of CD38 and CD138; and without CD20 or CD117 expression. Abnormal plasma cells represent 98.8% of total plasma cells in the sample. The abnormal population represents 3.2% of the total white cells by flow cytometry, and almost certainly will be underestimate in comparison to morphology. Abnormal plasma cells represent 98.8% of total plasma cells in the sample."
I did speak to my oncologist and asked him about the Hevylite assay to measure my IgA (as I saw you mention that in another post) and he said that he is on a research team working with the Hevylite and currently he didn't find it immensely accurate, but has hope for the future. He did acknowledge that IgA is difficult to measure.
Trying to determine what is the most significant to focus on. My oncologist did indicate my 98.8% abnormal cells may get me into a clinical trial if that was something I was looking to do.
I also have osteoporosis and had my first Zometa infusion this week.
I got my flow cytometry report and hematopathology a week or two ago:
Bone marrow, left posterior iliac crest, biopsy and aspirate smears:
30-40% involvement by CD138 immunohistochemistry, ranging from 80-20% with uneven distribution
17% involvement by aspriate differential
3.2% involvement by 10-color flow cytometry
Cellular marrow with trilineage maturing hematopoiesis
BCMA shows 3+ Golgi and membranous staining
Separate section:
"No abnormal mature B-cell population detected"
"Flow cytometry reveals abnormal plasma cell population expression of CD19 (absent), CD27 (absent), CD45 (absent), CD56 (bright), CD81 (absent) and monoclonal kappa cytoplasmic light chain restriction; with normal expression of CD38 and CD138; and without CD20 or CD117 expression. Abnormal plasma cells represent 98.8% of total plasma cells in the sample. The abnormal population represents 3.2% of the total white cells by flow cytometry, and almost certainly will be underestimate in comparison to morphology. Abnormal plasma cells represent 98.8% of total plasma cells in the sample."
I did speak to my oncologist and asked him about the Hevylite assay to measure my IgA (as I saw you mention that in another post) and he said that he is on a research team working with the Hevylite and currently he didn't find it immensely accurate, but has hope for the future. He did acknowledge that IgA is difficult to measure.
Trying to determine what is the most significant to focus on. My oncologist did indicate my 98.8% abnormal cells may get me into a clinical trial if that was something I was looking to do.
I also have osteoporosis and had my first Zometa infusion this week.
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Eileenk - Name: Eileen
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Smoldering, September 2017
- Age at diagnosis: 49
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