I was diagnosed with MGUS recently and just got access to my full bone marrow biopsy results in my portal. I know that deletion 13 is not good for prognosis in multiple myeloma, but the rest of the results I don't understand. If anyone could help me understand this better, I would appreciate it.
I am 50 years old and have several autoimmune diseases (lupus, Sjogrens, osteoarthritis, Raynauds, fibromyalgia). Thanks.
Fluorescence in situ hybridization (FISH) analysis
Multiple Myeloma Panel (CD138 Sorted)
Diagnosis: Multiple Myeloma
Specimen Source: Bone Marrow
Collection Date: 1/3/2017 4:41 PM
Report Date: 1/28/2017 7:00 PM
Interpretation:
CD 138 SORTED CELLS ARE POSITIVE FOR 13/13q DELETION, AND HYPOPLOIDY OF CEP3, CEP 9, AND CEP 11.
CD138 SORTED CELLS ARE NEGATIVE FOR IgH GENE REARRANGEMENT, t(4;14), t(11;14), t(14;16), t(14:20), TP53 DEL, SEE COMMENTS.
Comments: Please note that concurrent bone marrow biopsy reveals 3% kappa / lambda restricted monoclonal plasma cells. See biopsy report S-17-105. Correlation with cytogenetic study suggested.
nuc ish(D13S319x1,13q34x2)[20/100]
nuc ish(D3Z1x1)[18/100]
nuc ish(9p11-q11x1)[38/100]
nuc ish(D11Z1x1)[32/100
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CathyCav - Name: Cathy
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: DXd w/MGUS Jan 2017
- Age at diagnosis: 50
Re: Bone marrow biopsy / FISH results if have MGUS
Actually, del13 isn't considered a risk factor for progression to myeloma (which is what you likely care about as an MGUS patient), at least according to a recent study by the Mayo. See the article discussed in this forum thread:
"Great article - cytogenetics (chromosomal abnormalities)" (Nov 3, 2015)
In the article is the following statement in regard to del13:
"Monosomy 13/del(13q) had no impact on risk of progression."
You also don't have the big, bad dogs for risk of progression, namely t(4;14) or del(17p); TP53 del is tied to the del(17p) mutation and you are negative for TP53 del.
I'm not sure what "kappa / lambda restricted monoclonal plasma cells" means. If you have monoclonal plasma cells, they typically should be either lambda or kappa restricted (monotypic), but not both (unless you have a couple of different kinds of m-spikes). Normal plasma cells are polytypic and do express both kappa and lambda light chains. This would be something to ask your doctor about. What were the results of your serum immunofixation test? That might shed some more light on the situation.
I'm also not sure that your hypoploidy is a cause for concern. That would be another good question for your doctor.
"Great article - cytogenetics (chromosomal abnormalities)" (Nov 3, 2015)
In the article is the following statement in regard to del13:
"Monosomy 13/del(13q) had no impact on risk of progression."
You also don't have the big, bad dogs for risk of progression, namely t(4;14) or del(17p); TP53 del is tied to the del(17p) mutation and you are negative for TP53 del.
I'm not sure what "kappa / lambda restricted monoclonal plasma cells" means. If you have monoclonal plasma cells, they typically should be either lambda or kappa restricted (monotypic), but not both (unless you have a couple of different kinds of m-spikes). Normal plasma cells are polytypic and do express both kappa and lambda light chains. This would be something to ask your doctor about. What were the results of your serum immunofixation test? That might shed some more light on the situation.
I'm also not sure that your hypoploidy is a cause for concern. That would be another good question for your doctor.
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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 / FISH results if have MGUS
Thank you for your reply, Multibilly. 
Yes, I know it doesn't mean more likely to progress to multiple myeloma. But if I DO progress to multiple myeloma, it means less responsive to treatments and a worse prognosis.
I am IgA Kappa and my multiple myeloma specialist already told me that alone means a higher chance of progression.
Serum Immunofixation:
Faint bands noted in IgA and kappa.
Suggest retesting in 4-6 months, if clinically indicated.
Quantitative Immunoglobulins:
IgG 896 mg/dL (700 - 1600)
IgA 318 mg/dL ( 87 - 352)
IgM 54 mg/dL ( 26 - 217)
It was done 3 times in 3 1/2 months and the last time there was an M-spike.
Also, here are my serum free light chain results:
Free Kappa Lt Chains, Serum 21.45 mg/L (3.30 - 19.40)
Free Lambda Lt Chains, Serum 15.14 mg/L (5.71 - 26.30)
Kappa/Lambda Ratio 1.42 (0.26 - 1.65)
SPEP
Albumin 3.6 g/dL (2.9 - 4.4)
Alpha-1-Globulin 0.2 g/dL (0.0 - 0.4)
Alpha-2-Globulin 0.7 g/dL (0.4 - 1.0)
Beta Globulin 1.1 g/dL (0.7 - 1.3)
Gamma Globulin 1.0 g/dL (0.4 - 1.8)
M-Spike 0.4 g/dL
Globulin, Total 3.0 g/dL (2.2 - 3.9)
A/G Ratio 1.2 (0.7 - 1.7)
Intepretation:
The SPE pattern demonstrates a single peak (M-spike) in the gamma
region which may represent monoclonal protein. If clinically indicated,
the presence of a monoclonal gammopathy may be confirmed by immuno-
fixation, as well as an evaluation of the urine for the presence of
Bence-Jones protein.
Yes, I know it doesn't mean more likely to progress to multiple myeloma. But if I DO progress to multiple myeloma, it means less responsive to treatments and a worse prognosis.
I am IgA Kappa and my multiple myeloma specialist already told me that alone means a higher chance of progression.
Serum Immunofixation:
Faint bands noted in IgA and kappa.
Suggest retesting in 4-6 months, if clinically indicated.
Quantitative Immunoglobulins:
IgG 896 mg/dL (700 - 1600)
IgA 318 mg/dL ( 87 - 352)
IgM 54 mg/dL ( 26 - 217)
It was done 3 times in 3 1/2 months and the last time there was an M-spike.
Also, here are my serum free light chain results:
Free Kappa Lt Chains, Serum 21.45 mg/L (3.30 - 19.40)
Free Lambda Lt Chains, Serum 15.14 mg/L (5.71 - 26.30)
Kappa/Lambda Ratio 1.42 (0.26 - 1.65)
SPEP
Albumin 3.6 g/dL (2.9 - 4.4)
Alpha-1-Globulin 0.2 g/dL (0.0 - 0.4)
Alpha-2-Globulin 0.7 g/dL (0.4 - 1.0)
Beta Globulin 1.1 g/dL (0.7 - 1.3)
Gamma Globulin 1.0 g/dL (0.4 - 1.8)
M-Spike 0.4 g/dL
Globulin, Total 3.0 g/dL (2.2 - 3.9)
A/G Ratio 1.2 (0.7 - 1.7)
Intepretation:
The SPE pattern demonstrates a single peak (M-spike) in the gamma
region which may represent monoclonal protein. If clinically indicated,
the presence of a monoclonal gammopathy may be confirmed by immuno-
fixation, as well as an evaluation of the urine for the presence of
Bence-Jones protein.
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CathyCav - Name: Cathy
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: DXd w/MGUS Jan 2017
- Age at diagnosis: 50
Re: Bone marrow biopsy / FISH results if have MGUS
Cathy,
My wife's M-Spike is 1.7 g/dL (17 g/l), Her IgG is at 2317 (normal 650-1600). Kappa free light chain level is 65.2 (normal is 3.3 -19.4) and her kappa-lambda ratio is 8.6 (normal 0.3 to 1.65). Her bone marrow biopsy was normal: 5% plasma cells with no chromosome abnormalities on the FISH panel. My wife also has chronic neutropenia (low white blood counts) requiring weekly injections. She also has Meneire's disease and peripheral neuropathy - both autoimmune.
I noticed your other medical history that you posted. My wife's hematologist is monitoring her blood closely each week, but he is primarily focused that all her blood problems may be caused by an autoimmune disorder.
My wife's M-Spike is 1.7 g/dL (17 g/l), Her IgG is at 2317 (normal 650-1600). Kappa free light chain level is 65.2 (normal is 3.3 -19.4) and her kappa-lambda ratio is 8.6 (normal 0.3 to 1.65). Her bone marrow biopsy was normal: 5% plasma cells with no chromosome abnormalities on the FISH panel. My wife also has chronic neutropenia (low white blood counts) requiring weekly injections. She also has Meneire's disease and peripheral neuropathy - both autoimmune.
I noticed your other medical history that you posted. My wife's hematologist is monitoring her blood closely each week, but he is primarily focused that all her blood problems may be caused by an autoimmune disorder.
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LuvHiking - Name: LuvHiking
- Who do you know with myeloma?: Wife
- When were you/they diagnosed?: Waiting for diagnosis
- Age at diagnosis: 50
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