Hello it is very difficult to find information on understanding bone marrow results related to MGUS and/or multiple myeloma stages including indicators on precursers and what they many mean.
I am curious to understand how the markers are important and how often there are abnormal results in the marrow not yet showing in the blood - How do you know which questions you should be asking next?
Fish for Plasma cell Prolifer Disorder:
Insufficient plasma cells were observed. This result does not exclude proliferative disorder.
200 cell counts - lymphocyte, neurtophil, metamyelocyte, promyelocyte, blast, monocyte, esoinophil basophil - all within normal range
500 cell counts -blast 4.0H, Promyleocytes 0.6L, other granulocyte precursors 49.8H, Erthroid precursors 27.8H - other counts within range
1. How can a 200 cell count vs a 500 cell count give different counts or indications of High/Low results.
Cellularity: slightly hypocellular
Erthoroid Elements: full spectrum maturation with mild stress dyserythropoiesis
2. what is dyserythropoiesis in the bone marrow? How does it show in the bone marrow and not the blood?
Myeloid Elements - marginal increase
3. Does Myeloid elements show up in MGUS, Myeloma or only the leukemia subsets
Megakaryoctytes: Increased with unremarkable morphology
there is no significant rouleaux formation
occassional reactive lymphocytes
Antigens analyzed:
cd19, cd20, cd45, cd56 and lambda negative
cd38 and ckappa bright
CD138 moderate which comprise 6-8% of marrow cellularity
CD117 Kit - Positive dim
plasma cells predominantely kappa light chain
How does a CD117+ influence decisions on the next step? Or doesn't it?
I hope I haven't included too much information. I'm trying to understand as right now i'm being 'watched for MDS or other now too and am trying to understand if i should simply be being watched or if there are other markers panels that should be done based on the above. Or is waiting the proper course.
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Re: Bone Marrow Biopsy - Low Level Plasma Cell Neoplasm
CD 117 can be expressed on abnormal plasma cells. It is not typically a "normal" marker for plasma cells.
I think the marrow described is consistent with MGUS provided no CRAB criteria are present in blood or on imaging.
I think the marrow described is consistent with MGUS provided no CRAB criteria are present in blood or on imaging.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: Bone Marrow Biopsy - Low Level Plasma Cell Neoplasm
thank you
i have increased unexplained symptoms and am being shuffled from doc to doc right now
including extreme fatique, sensory neuropathy, 'stiff man syndrome - type of spasms', and now lesions are starting to appear on the abdomen and legs - pinprick redish dots 100's of them. Joints are deforming, Ischiofemoral impingement in both hips (i've never had hip replacement). Femurs and shoulders are showing edema internal - no injuries
my understanding is MGUS has no symptoms. Is that accurate? I've read many stories contradicting that statement. Without the symptoms, MGUS would be an easy answer.
i have increased unexplained symptoms and am being shuffled from doc to doc right now
including extreme fatique, sensory neuropathy, 'stiff man syndrome - type of spasms', and now lesions are starting to appear on the abdomen and legs - pinprick redish dots 100's of them. Joints are deforming, Ischiofemoral impingement in both hips (i've never had hip replacement). Femurs and shoulders are showing edema internal - no injuries
my understanding is MGUS has no symptoms. Is that accurate? I've read many stories contradicting that statement. Without the symptoms, MGUS would be an easy answer.
Last edited by curious on Tue Mar 26, 2013 9:09 pm, edited 1 time in total.
Re: Bone Marrow Biopsy - Low Level Plasma Cell Neoplasm
Took a call today from hemo they may start me on a drug used for lymphoma. Can't recall the name. Still confused about the cd117 connection. Pathologists are re-evaluating. Mgus would not be treated correct?
Re: Bone Marrow Biopsy - Low Level Plasma Cell Neoplasm
It is correct that with MGUS you have no symptoms. However, there are certainly disorders of plasma cells that may not meet diagnostic criteria for multiple myeloma, but require treatment. The abnormal plasma cell makes an antibody (immunoglobulin) that may affect the body in many ways. Neurologic symptoms may be one of the ways that this manifests.
If treatment with chemotherapy is planned, I would favor therapy with activity against the plasma cells, as this was the abnormality identified in the bone marrow. Treatments considered could be cytoxan, lenalidomide, dexamethasone. But I would not use Rituxan in your case (another lymphoma drug) as there was not a CD20+ abnormal cell in the bone marrow.
In reviewing the symptoms, this may fall under a diagnosis known as POEMS syndrome. An EMG (nerve test) would be helpful in making this diagnosis if not already done. Please let me know if I can help.
If treatment with chemotherapy is planned, I would favor therapy with activity against the plasma cells, as this was the abnormality identified in the bone marrow. Treatments considered could be cytoxan, lenalidomide, dexamethasone. But I would not use Rituxan in your case (another lymphoma drug) as there was not a CD20+ abnormal cell in the bone marrow.
In reviewing the symptoms, this may fall under a diagnosis known as POEMS syndrome. An EMG (nerve test) would be helpful in making this diagnosis if not already done. Please let me know if I can help.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: Bone Marrow Biopsy - Low Level Plasma Cell Neoplasm
Thank you again Dr. Valent
I also understand MGUS will not show an increase in protein -
I have been showing a very slight steady slow increase over the past year. However it still remains low overall.
The Antibody that you refer to is it a marker? like the cd117? or different?
And your thought would be consistent with what the dermatologists indicated about the lesions on the skin as far as POEMS, her report has indicated POEMS can not be ruled out.
An EMG is being ordered. I do not know yet if that is the determining factor for treatment or the re-evaluation the the biopsy is, or perhaps both.
Will abnormalities show on EMG with MDS? I know it will with POEMS at least at some point.
Rituxan is the drug that was mentioned. I'm not sure yet how you can help more than you are with your communications, which is much appreciated. This is complicated and I understand that.
I think I should see what the re-evaluation shows and if they suggest starting the Rituxan maybe I need a second opinion? I will know more within 1 week.
I also understand MGUS will not show an increase in protein -
I have been showing a very slight steady slow increase over the past year. However it still remains low overall.
The Antibody that you refer to is it a marker? like the cd117? or different?
And your thought would be consistent with what the dermatologists indicated about the lesions on the skin as far as POEMS, her report has indicated POEMS can not be ruled out.
An EMG is being ordered. I do not know yet if that is the determining factor for treatment or the re-evaluation the the biopsy is, or perhaps both.
Will abnormalities show on EMG with MDS? I know it will with POEMS at least at some point.
Rituxan is the drug that was mentioned. I'm not sure yet how you can help more than you are with your communications, which is much appreciated. This is complicated and I understand that.
I think I should see what the re-evaluation shows and if they suggest starting the Rituxan maybe I need a second opinion? I will know more within 1 week.
Re: Bone Marrow Biopsy - Low Level Plasma Cell Neoplasm
MGUS patients can have increasing protein (the M-protein or M-spike). It is a blood marker of the antibody/immunoglobulin made by the abnormal plasma cell. Globulin (immunoglobulin) is just a fancy medical term for protein. Although, as you are having many systemic symptoms, I do not think this is just an incidental finding.
I don't think this is MDS based on bone marrow report. But you are correct that MDS does not cause nerve symptoms.
If the EMG is abnormal (particularly showing demyelinating polyneuropathy) then I would treat as POEMS. However, if there is something specific from the skin biopsy raising suspicion for POEMS, then just about any abnormality in the EMG would lead me to favor anti-plasma cell therapy for POEMS as responses can be quite rapid and neurologic improvement expected. I use Revlimid, cytoxan and dexamethasone to treat POEMS. At a minimum, cytoxan and dexamethasone can be started relatively quickly until you are able to obtain the Revlimid. There are a few hoops to jump through to get the Revlimid.
I don't think this is MDS based on bone marrow report. But you are correct that MDS does not cause nerve symptoms.
If the EMG is abnormal (particularly showing demyelinating polyneuropathy) then I would treat as POEMS. However, if there is something specific from the skin biopsy raising suspicion for POEMS, then just about any abnormality in the EMG would lead me to favor anti-plasma cell therapy for POEMS as responses can be quite rapid and neurologic improvement expected. I use Revlimid, cytoxan and dexamethasone to treat POEMS. At a minimum, cytoxan and dexamethasone can be started relatively quickly until you are able to obtain the Revlimid. There are a few hoops to jump through to get the Revlimid.
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: Bone Marrow Biopsy - Low Level Plasma Cell Neoplasm
Today my Neuro Team called -
They will start treatment next week for paroxysmal dyskinesias -
They will start treatment next week for paroxysmal dyskinesias -
Re: Bone Marrow Biopsy - Low Level Plasma Cell Neoplasm
any word on an EMG?
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Dr. Jason Valent - Name: Jason Valent, M.D.
Beacon Medical Advisor
Re: Bone Marrow Biopsy - Low Level Plasma Cell Neoplasm
Thank you Dr. Valent for your continued interest.
I understand the emg is being scheduled.
I understand the drugs that are being started from the neuro will be a combination of anti convulsants but don't know which ones yet.
I will post drugs after Wednesday appointment
The hematologist will have re-read on the bone marrow and the neurosurgeon report next week. I will repost what I am told.
I did find some NIH studies related to paroxysmal dyskinesia and paraneoplastic how do you determine if related or two different issues? It indicates rare but should be considered. And it also indicates if treated with low dose chemo the neuro symptoms go away.
Although the paroxysmal dyskinesia makes sense from the neuro standpoint as to what i have been going through it doesn't account for the lesions. At least that I know of.
I understand the emg is being scheduled.
I understand the drugs that are being started from the neuro will be a combination of anti convulsants but don't know which ones yet.
I will post drugs after Wednesday appointment
The hematologist will have re-read on the bone marrow and the neurosurgeon report next week. I will repost what I am told.
I did find some NIH studies related to paroxysmal dyskinesia and paraneoplastic how do you determine if related or two different issues? It indicates rare but should be considered. And it also indicates if treated with low dose chemo the neuro symptoms go away.
Although the paroxysmal dyskinesia makes sense from the neuro standpoint as to what i have been going through it doesn't account for the lesions. At least that I know of.
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