Hi everyone, I found the Myeloma Beacon when we first suspected my brother had multiple myeloma. I was calmed considerably and comforted to read so many well written, detailed, smart and articulate posts in the forum, news articles, and patient columns. Thank you very much.
My brother is 54 years old and 2 weeks ago was diagnosed with multiple myeloma. He saw a general oncologist and was not at all informed about multiple myeloma, so he asked very few questions and did not recall much of what was said during the appointment (understandably). He came away only knowing that he had it - that's it.
To that date, he had blood work and a bone marrow biopsy completed. He was sent directly from the appointment to the hospital for a skeletal x-ray. We do not have the results of the biopsy or the x-ray right now.
I got him a 2nd opinion appointment with a multiple myeloma specialist at a major cancer center in his area; the appointment will be in about 2 weeks time. The specialist he will soon see will gather all of his records and results in time for his appointment with them.
We understand that he has multiple myeloma. We also know that he must be with a specialist, so the second opinion is more about understanding the type of multiple myeloma he has and the plan for treatment.
He was able to log in to the lab that has his blood test results - at least one set - and he sent them to me this evening. Thanks to this forum, I had already put together a spreadsheet and had spent many, many, hours defining and developing an understanding for each reading you all had listed here as important to track.
So now I sit looking at these lab results and I have a few questions I hope you can help me with.
Here are the results that were either not in the normal range or seemed important to note.
BUN: 22 mg/dL 7-25 mg/dL
Creatinine: 1.10 mg/dL 0.70-1.33 mg/dL
Calcium: 9.4 mg/dL 8.6-10.3 mg/dL
Total Protein: 9.2 g/dL 6.1-8.1 g/dL
Albumin: 4.0 g/dL 3.6-5.1 g/dL
Globulin: 5.2 g/dL 1.9-3.7 g/dL
A/G ratio: 0.8 1.0-2.5 (calc)
ALT: 51U/L 9-46 U/L
IgA: 3885 mg/dL 81-463 mg/dL
IgG: 596 mg/dL 694-1618 mg/dL
IgM: 10 mg/dL 48-271 mg/dL
Interpretation:
Two monoclonal IgA (kappa) immunoglobulins are detected. This suggests either biclonal gammopathy or monoclonal gammopathy with two electrophoretically different immunoglobulin components.
Protein Electrophoresis
(only reporting non normal marks)
Beta Globulins: 3.4 g/dL 0.8-1.4 g/dL
Abnormal Protein Band 1: 2.4 g/dL None detected
Abnormal Protein Band 2: 0.5 g/dL None detected
Interpretation:
Visual inspection of the electropherogram reveals the presence of a marked concentration peak migrating in the beta2-anodal gamma region and a low concentration peak migrating in the anodal gamma region. Immunofixation studies may be of assistance.
There was no mention of RBC or HGB
I cannot determine how to calculate his M-spike. Can anyone help me?
I do not know what to make of the IgA, IgM, or IgG results - what do they mean?
From this report, we think he has IgA kappa multiple myeloma - is that correct?
From this report, since calcium is normal, we hope this means limited, if any, bone involvement - is that a logical conclusion?
From this report, since his BUN and creatinine are normal, we hope this means kidney and liver have not been impacted yet - is that logical?
I hope I've provided enough information for somebody to answer my questions.
I also hope to participate on this forum as a care taker in order to help the next frightened person (such as myself) who, in the dead of night, comes across this wonderful resource.
Thanks
Forums
9 posts
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greenrobin - Who do you know with myeloma?: My brother
- When were you/they diagnosed?: 12/2014
- Age at diagnosis: 54
Re: Brother has multiple myeloma - his labs & questions
Hi Greenrobin,
Welcome to the forum.
First off, I'm not a doc, so please verify all this with one.
You need to find the report that is labelled Serum Potein Electrophoresis (SPEP) to find the M-spike value. It may appear as a separate entry on the report and in a different location from where you find the other lab values. Note that this value doesn't always make it over to online lab summaries, so you may have to ask the doctor's office for a copy of this specific lab.
On the SPEP, the M-spike may also be labeled as "M-protein", "paraprotein", "monoclonal protein", etc.
Yes, it looks like IgA kappa type of multiple myeloma. This is why the IgA level reads high. The IgG and IgM are likely reading low due to a phenomenon known as immunoparesis, which happens a fair amount with IgA-type multiple myeloma. If it is a bi-clonal gammopathy, this does not mean any difference in prognosis or the treatment approach one may select.
The RBC and HGB values should be found on the report labeled "CBC".
A normal serum calcium level does not necessarily mean that your brother may not have bone involvement. You need a PET/CT or MRI to really determine this. A skeletal survey xray is an "OK" starting point for evaluating newly diagnosed patients, but has limitations in detecting lytic lesions associated with multiple myeloma.
With a good BUN and creatinine level, he likely does not have kidney involvement.
But, again, you need to verify all this with an MD.
Best of luck to you and your brother.
Welcome to the forum.
First off, I'm not a doc, so please verify all this with one.
You need to find the report that is labelled Serum Potein Electrophoresis (SPEP) to find the M-spike value. It may appear as a separate entry on the report and in a different location from where you find the other lab values. Note that this value doesn't always make it over to online lab summaries, so you may have to ask the doctor's office for a copy of this specific lab.
On the SPEP, the M-spike may also be labeled as "M-protein", "paraprotein", "monoclonal protein", etc.
Yes, it looks like IgA kappa type of multiple myeloma. This is why the IgA level reads high. The IgG and IgM are likely reading low due to a phenomenon known as immunoparesis, which happens a fair amount with IgA-type multiple myeloma. If it is a bi-clonal gammopathy, this does not mean any difference in prognosis or the treatment approach one may select.
The RBC and HGB values should be found on the report labeled "CBC".
A normal serum calcium level does not necessarily mean that your brother may not have bone involvement. You need a PET/CT or MRI to really determine this. A skeletal survey xray is an "OK" starting point for evaluating newly diagnosed patients, but has limitations in detecting lytic lesions associated with multiple myeloma.
With a good BUN and creatinine level, he likely does not have kidney involvement.
But, again, you need to verify all this with an MD.
Best of luck to you and your brother.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Brother has multiple myeloma - his labs & questions
Greenrobin -
Just a note to say that your brother is lucky to have you in his corner. Getting him in to see a myeloma specialist should be very helpful.
Best wishes to the two of you.
Just a note to say that your brother is lucky to have you in his corner. Getting him in to see a myeloma specialist should be very helpful.
Best wishes to the two of you.
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Mike F - Name: Mike F
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: May 18, 2012
- Age at diagnosis: 53
Re: Brother has multiple myeloma - his labs & questions
Seeing a myeloma specialist is quite important. I am glad you were there to help out. The disease staging, treatments, and toxicities should be overseen by an expert. Most community oncologist see very few multiple myeloma patients and our patients can be quite complicated.
From the list of labs (obviously, without Hgb as a measure of anemia), your brother has IgA kappa multiple myeloma without hypercalcemia or renal failure / insufficiency at this time.
You will want to follow results in his labs related to two things:
Multiple Myeloma Labs / Numbers
Best of luck and please keep us updated.
From the list of labs (obviously, without Hgb as a measure of anemia), your brother has IgA kappa multiple myeloma without hypercalcemia or renal failure / insufficiency at this time.
You will want to follow results in his labs related to two things:
- The "CRAB" criteria -Signs of end organ damage from the myeloma, and
- Myeloma numbers - Quantification of the antibodies (proteins) being made by the multiple myeloma (either to watch for signs of disease progression, or, hopefully, excellent response to therapy).
- Calcium - His was normal
- Renal (Kidney) Failure - We follow BUN, creatinine, and total protein from 24 hour urine. Both of his BUN and Cr are within normal range.
- Anemia - Hgb, HCT (measure of bone marrow function).
- Bone - This is actually tracked using imaging: x-ray bone survey, PET/CT, or MRI.
Multiple Myeloma Labs / Numbers
- Serum M-spike (SPEP-IFE) - True measure of paraprotein (normal ="0"). Your brother appears to have peaks 2.4 + 0.5= 2.9 gram (These are in the beta globulin component, where IgA typically runs; most myeloma demonstrates an elevated gamma globulin region, as IgG myelomais more frequent). The IFE (immunofixation) states IgA kappa - the 2 components of the antibody being produced by the myeloma cells.
- Urine M-spike (UPEP-IFE) - True measure of urine paraprotein; did not see this value for your brother (24-hour urine collection).
- Quantitative immunoglobulins - IgA in your brother's case; 3885 mg/dL [elevated]). Is another less-specific way to monitor the disease. This also includes normal IgAs being made by non-disease B cells. As such, it is less specific and has a range of normal.
- SFLC (serum free light chains) - Should also be ordered as a measurement of the light chain component. I did not see this lab value for your brother.
Best of luck and please keep us updated.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Brother has multiple myeloma - his labs & questions
Thanks for your kind and helpful words, Multibilly, Mike F, and Dr. Shain. I have a profound feeling of gratitude to have been afforded the opportunity to connect with you.
More information since my initial post:
Bone x-ray report came back clean - no lesions found. I understand we should ask for an MRI now and we will. My brother does feel what he thinks is bone pain in his spine.
We found another lab report from the beginning of December that showed:
White blood cell count: 4.1 3.8 - 10.8 Thousand/uL
Red blood cell count: 3.54 (L) 4.20 - 5.80 Million/uL
Hemoglobin: 12.7 (L) 13.2 - 17.1 g/dL
Hematocrit: 37.1 (L) 38.5 - 50.0 %
MCV: 104.8 (H) 80.0 - 100.0 fL
MCH: 35.8 (H) 27.0 - 33.0 pg
So we now know that he has anemia and therefore, including his other lab results, has met the CRAB criteria required to be classified as having active multiple myeloma. Is that correct?
Is there anything else we can learn from the addition of the above lab work?
Urine SPEP and SFLC will hopefully be ordered by his new specialist. Still no sign of B2M on any lab results but perhaps I am just not seeing it?? Time will tell.
We haven't gotten our hands on the bone marrow biopsy result and have no idea what that will tell us. Hopefully we'll get a copy soon. The first oncologist he saw never even called my brother to tell him the result of his skeletal x-ray. He went and picked up the results from the hospital himself. Odd behavior from this doctor, indeed!
Best wishes.
More information since my initial post:
Bone x-ray report came back clean - no lesions found. I understand we should ask for an MRI now and we will. My brother does feel what he thinks is bone pain in his spine.
We found another lab report from the beginning of December that showed:
White blood cell count: 4.1 3.8 - 10.8 Thousand/uL
Red blood cell count: 3.54 (L) 4.20 - 5.80 Million/uL
Hemoglobin: 12.7 (L) 13.2 - 17.1 g/dL
Hematocrit: 37.1 (L) 38.5 - 50.0 %
MCV: 104.8 (H) 80.0 - 100.0 fL
MCH: 35.8 (H) 27.0 - 33.0 pg
So we now know that he has anemia and therefore, including his other lab results, has met the CRAB criteria required to be classified as having active multiple myeloma. Is that correct?
Is there anything else we can learn from the addition of the above lab work?
Urine SPEP and SFLC will hopefully be ordered by his new specialist. Still no sign of B2M on any lab results but perhaps I am just not seeing it?? Time will tell.
We haven't gotten our hands on the bone marrow biopsy result and have no idea what that will tell us. Hopefully we'll get a copy soon. The first oncologist he saw never even called my brother to tell him the result of his skeletal x-ray. He went and picked up the results from the hospital himself. Odd behavior from this doctor, indeed!
Best wishes.
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greenrobin - Who do you know with myeloma?: My brother
- When were you/they diagnosed?: 12/2014
- Age at diagnosis: 54
Re: Brother has multiple myeloma - his labs & questions
Hi greenrobin,
You are in good hands so far with those who have given you feedback, and they should probably be the ones who continue to give you advice. However, I did have a few thoughts I wanted to throw into the mix.
Maybe I'm missing something, but I'm not sure anything you have shared with us so far convincingly demonstrates that your brother's diagnosis should multiple myeloma, as opposed to smoldering multiple myeloma or even just MGUS.
Your brother doesn't have hypercalcemia, kidney damage, or bone damage (at least as far as can be seen so far). Your brother is slightly anemic, but he's not so anemic that it qualifies as one of the "CRAB" symptoms. You have to have either a hemoglobin below 10 g/dL, or 2 g/dL below the lower limit of the normal range, for anemia to be considered organ damage from multiple myeloma. Your brother's hemoglobin level is 12.7, which is just 0.5 under the lower limit.
A couple results seem like they will be really important in finalizing your brother's diagnosis.
One is the results of his serum free light chain testing. Has he had that sort of testing done and, if so, what were the results? The numbers would be for kappa free light chains, lambda free light chains, and the kappa/lambda ratio.
The other important set of results would be those from his bone marrow biopsy, particularly the bone marrow plasma cell percentage.
Of course, the results of an MRI or, in particular, a PET scan would be very helpful, as well.
I admit that, with slight anemia and a somewhat elevated, but still within normal range, creatinine level, there are subtle signs that your brother's monoclonal gammopathy may be starting to cause organ damage. But these are very subtle signs, it seems to me, and certainly not ones that call for a multiple myeloma diagnosis right now.
Again, I may be missing something, and I'm not a physician. These are just my impressions from what you've shared with us so far and what I've read about the criteria for a myeloma diagnosis.
Hope this helps, and good luck to your brother!
You are in good hands so far with those who have given you feedback, and they should probably be the ones who continue to give you advice. However, I did have a few thoughts I wanted to throw into the mix.
Maybe I'm missing something, but I'm not sure anything you have shared with us so far convincingly demonstrates that your brother's diagnosis should multiple myeloma, as opposed to smoldering multiple myeloma or even just MGUS.
Your brother doesn't have hypercalcemia, kidney damage, or bone damage (at least as far as can be seen so far). Your brother is slightly anemic, but he's not so anemic that it qualifies as one of the "CRAB" symptoms. You have to have either a hemoglobin below 10 g/dL, or 2 g/dL below the lower limit of the normal range, for anemia to be considered organ damage from multiple myeloma. Your brother's hemoglobin level is 12.7, which is just 0.5 under the lower limit.
A couple results seem like they will be really important in finalizing your brother's diagnosis.
One is the results of his serum free light chain testing. Has he had that sort of testing done and, if so, what were the results? The numbers would be for kappa free light chains, lambda free light chains, and the kappa/lambda ratio.
The other important set of results would be those from his bone marrow biopsy, particularly the bone marrow plasma cell percentage.
Of course, the results of an MRI or, in particular, a PET scan would be very helpful, as well.
I admit that, with slight anemia and a somewhat elevated, but still within normal range, creatinine level, there are subtle signs that your brother's monoclonal gammopathy may be starting to cause organ damage. But these are very subtle signs, it seems to me, and certainly not ones that call for a multiple myeloma diagnosis right now.
Again, I may be missing something, and I'm not a physician. These are just my impressions from what you've shared with us so far and what I've read about the criteria for a myeloma diagnosis.
Hope this helps, and good luck to your brother!
Re: Brother has multiple myeloma - his labs & questions
Thank you for the additional information.
The anemia is slight, just below normal levels. I would ensure that this is not his baseline or the result of other issues (iron, folate, vitamin B12 deficiency, or other likely causes of anemia). To me, a 12.7 would not push me to initiate therapy, unless it demonstrates a large drop from baseline (that is, more than 2 g drop from the patient's baseline).
With his back pain I would suggest an MRI of his CTL spine +/- pelvis (cervical, thoracic, and lumbar). Bone surveys are an excellent screen for lytic bone disease, but I would argue that they are not the most sensitive. You need to have ~30 percent cortical bone destruction before a lesion can be detected. Nor are surveys very good for visualization of the spine. So, MRI, as above, or PET/CT are very reasonable imaging options.
Without one of the CRAB criteria or a multiple myeloma-defining event,
1. More than 1 lesion on MRI or PET/CT,
2. Bone marrow biopsy report showing greater than 60 % plasma cells, or
3. SFLC report showing greater than 100 ratio of involved / uninvolved light chains
this will be categorized as smoldering / inactive multiple myeloma and quarterly multiple myeloma labs with annual imaging would be the way to go forward.
Additional critical pieces of information that are needed:
The anemia is slight, just below normal levels. I would ensure that this is not his baseline or the result of other issues (iron, folate, vitamin B12 deficiency, or other likely causes of anemia). To me, a 12.7 would not push me to initiate therapy, unless it demonstrates a large drop from baseline (that is, more than 2 g drop from the patient's baseline).
With his back pain I would suggest an MRI of his CTL spine +/- pelvis (cervical, thoracic, and lumbar). Bone surveys are an excellent screen for lytic bone disease, but I would argue that they are not the most sensitive. You need to have ~30 percent cortical bone destruction before a lesion can be detected. Nor are surveys very good for visualization of the spine. So, MRI, as above, or PET/CT are very reasonable imaging options.
Without one of the CRAB criteria or a multiple myeloma-defining event,
1. More than 1 lesion on MRI or PET/CT,
2. Bone marrow biopsy report showing greater than 60 % plasma cells, or
3. SFLC report showing greater than 100 ratio of involved / uninvolved light chains
this will be categorized as smoldering / inactive multiple myeloma and quarterly multiple myeloma labs with annual imaging would be the way to go forward.
Additional critical pieces of information that are needed:
- ISS staging, which requires beta 2 microglobulin and albumin
- Risk-related information: FISH results (MM-specific), metaphase cytogenetics, and/or MyPRS (GEP) results.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Brother has multiple myeloma - his labs & questions
Thanks again for everything. We appreciate every comment and hope this info is helpful for others to read. We hope the Beacon staff will let us know if this is too much information to put in the Forum here at The Myeloma Beacon. I try to refrain from posting lab and test results piecemeal and wait until I have a critical mass - I cant stress how important it feels for me to be able to post this data here (but would understand if told its too much)
Thanks and Best Wishes
I was able to get my brothers lab results since 2012 from his PCP. This test shows low RBC even 2 years ago, details below.
We got a copy of the most recent 12/29/2014 lab report providing B2M.
We got a copy of the bone marrow biopsy report.
Abnormal results from May 2012 lab results:
RBC (L): 3.92 Million/uL 4.20 – 5.80 Million/uL
Glucose (H): 108 mg/dL 65 – 99 mg/dL
MCV (H): 104.6 fl 80-100 fl
MCH (H): 36.0 pg 27.0 – 33.0 pg
All else was normal (Total Protein, Calcium, Albumin, Globulin, BUN, Creatinine, HGB etc)
Abnormal results from November 4, 2013
Total Protein (H): 8.2 g/dL 6.1 – 8.1 g/dL
Globulin (H): 3.8g/dL (calc) 1.9 – 3.7 g/dL (calc)
ALT (H): 51 U/L 9 – 46 U/L
For some reason no results were given for RBC
Everything else was in the normal range (Creatinine, Albumin, Globulin, Calcium, Total Protein)
The lab results in my first post above pick up from here.
Latest lab results from December 29, 2014 (this is new info)
RBC (L): 3.40Million/uL 4.20 – 5.80 Million/uL
HGB (L): 12.3 g/dL 13.2 – 17.2 g/dL
Hematrocrit (L): 35.5 % 38.5 – 50.0%
B2M, Serum (H): 2.97mg/L < OR = 2.51 mg/L
Kappa Lambda Light Chains Free with Ratio, Serum
Kappa Light Chain, Free, Serum (H): 89.2 mg/L
Lambda Light Chain, Free, Serum : 6.1 mg/L
K/L Light Chains free ratio, serum (H): 14.62
Bone Marrow Biopsy Results December 18, 2014
Genetic Analysis
Normal Cytogenetic Result
Comment: This result does not rule out a hematological malignancy. Subtle rearrangements or the presence of an aberrant clone is a low proportion of cells cannot be ruled out.
46, XY (20)
Cells examined: 20
Cells analyzed: 20
Cells Karyotyped: 2
Bandings/Staining tech: GTG
Band resolution: 400
Bone Marrow Morphologic Evaluation
Marrow aspirate, biopsy, and clot section:
Marrow plasmacytosis (10%) with cy-kappa light chain restriction by flow cytometry. A diagnosis of multiple myeloma is favored
Comment: The flow cytometry findings demonstrated 4% monoclonal plasma cells with cy-kappa light chain restriction. The routine marrow aspirate and biopsy studies demonstrate a higher percentage of plasma cells exceeding 10% with frequent clusters in the marrow, multiple myeloma is the favored diagnosis. Cytogenic studies are pending.
Differential %
Band Neutrophils 12%, Plasma Cells 10%
Peripheral blood: No hemogram or peripheral smear provided
Marrow aspirate smears: The smears are aspicular but adequate for evaluation. Examination of nucleated cells demonstrates that all cell lines are present with a relative decreased erythroid precursors and increased plasma cells at 10% of the nucleated cell population. Megakaryotypes not identified. No cells extrinsic to the marrow are identified.
Marrow biopsy (unilateral): the marrow demonstrates mild hypocellularity at 35%. Trilineage hematopiesis is present with sequential maturation and an apparently normal M:E ratio of 2:1. Megakaryotypes are adequate and evenly distributed. Plasma cells are increased both diffusely and in clusters.
Clot section: The clot section material correlates with the biopsy material and demonstrates frequent clusters of plasma cells. Plasma cells account for >10% of the nucleated cell population.
Iron stains: Iron is inadequate. No ring sideroblasts are identified.
Reticulin stain: No increase in reticulin fibrosis seen.
Leukemia/Lymphoma karyotyping
Plasma Cell dyscrasia, cy-kappa light chain clonal (4% of the analyzed cell population)
Comment: Flow cytometry demonstrates a monoclonal plasma cell population accounting for 4% of the analyzed cell population. It should be noted that plasma cells tend to be underrepresented in specimens prepared for flow cytometry. The differential diagnosis in this case includes MGUS and smoldering myeloma or multiple myeloma. Final interpretation requires correlation with clinical, morphologic, radiographic, and the pending cytogenic analysis findings.
Thanks and Best Wishes
I was able to get my brothers lab results since 2012 from his PCP. This test shows low RBC even 2 years ago, details below.
We got a copy of the most recent 12/29/2014 lab report providing B2M.
We got a copy of the bone marrow biopsy report.
Abnormal results from May 2012 lab results:
RBC (L): 3.92 Million/uL 4.20 – 5.80 Million/uL
Glucose (H): 108 mg/dL 65 – 99 mg/dL
MCV (H): 104.6 fl 80-100 fl
MCH (H): 36.0 pg 27.0 – 33.0 pg
All else was normal (Total Protein, Calcium, Albumin, Globulin, BUN, Creatinine, HGB etc)
Abnormal results from November 4, 2013
Total Protein (H): 8.2 g/dL 6.1 – 8.1 g/dL
Globulin (H): 3.8g/dL (calc) 1.9 – 3.7 g/dL (calc)
ALT (H): 51 U/L 9 – 46 U/L
For some reason no results were given for RBC
Everything else was in the normal range (Creatinine, Albumin, Globulin, Calcium, Total Protein)
The lab results in my first post above pick up from here.
Latest lab results from December 29, 2014 (this is new info)
RBC (L): 3.40Million/uL 4.20 – 5.80 Million/uL
HGB (L): 12.3 g/dL 13.2 – 17.2 g/dL
Hematrocrit (L): 35.5 % 38.5 – 50.0%
B2M, Serum (H): 2.97mg/L < OR = 2.51 mg/L
Kappa Lambda Light Chains Free with Ratio, Serum
Kappa Light Chain, Free, Serum (H): 89.2 mg/L
Lambda Light Chain, Free, Serum : 6.1 mg/L
K/L Light Chains free ratio, serum (H): 14.62
Bone Marrow Biopsy Results December 18, 2014
Genetic Analysis
Normal Cytogenetic Result
Comment: This result does not rule out a hematological malignancy. Subtle rearrangements or the presence of an aberrant clone is a low proportion of cells cannot be ruled out.
46, XY (20)
Cells examined: 20
Cells analyzed: 20
Cells Karyotyped: 2
Bandings/Staining tech: GTG
Band resolution: 400
Bone Marrow Morphologic Evaluation
Marrow aspirate, biopsy, and clot section:
Marrow plasmacytosis (10%) with cy-kappa light chain restriction by flow cytometry. A diagnosis of multiple myeloma is favored
Comment: The flow cytometry findings demonstrated 4% monoclonal plasma cells with cy-kappa light chain restriction. The routine marrow aspirate and biopsy studies demonstrate a higher percentage of plasma cells exceeding 10% with frequent clusters in the marrow, multiple myeloma is the favored diagnosis. Cytogenic studies are pending.
Differential %
Band Neutrophils 12%, Plasma Cells 10%
Peripheral blood: No hemogram or peripheral smear provided
Marrow aspirate smears: The smears are aspicular but adequate for evaluation. Examination of nucleated cells demonstrates that all cell lines are present with a relative decreased erythroid precursors and increased plasma cells at 10% of the nucleated cell population. Megakaryotypes not identified. No cells extrinsic to the marrow are identified.
Marrow biopsy (unilateral): the marrow demonstrates mild hypocellularity at 35%. Trilineage hematopiesis is present with sequential maturation and an apparently normal M:E ratio of 2:1. Megakaryotypes are adequate and evenly distributed. Plasma cells are increased both diffusely and in clusters.
Clot section: The clot section material correlates with the biopsy material and demonstrates frequent clusters of plasma cells. Plasma cells account for >10% of the nucleated cell population.
Iron stains: Iron is inadequate. No ring sideroblasts are identified.
Reticulin stain: No increase in reticulin fibrosis seen.
Leukemia/Lymphoma karyotyping
Plasma Cell dyscrasia, cy-kappa light chain clonal (4% of the analyzed cell population)
Comment: Flow cytometry demonstrates a monoclonal plasma cell population accounting for 4% of the analyzed cell population. It should be noted that plasma cells tend to be underrepresented in specimens prepared for flow cytometry. The differential diagnosis in this case includes MGUS and smoldering myeloma or multiple myeloma. Final interpretation requires correlation with clinical, morphologic, radiographic, and the pending cytogenic analysis findings.
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greenrobin - Who do you know with myeloma?: My brother
- When were you/they diagnosed?: 12/2014
- Age at diagnosis: 54
Re: Brother has multiple myeloma - his labs & questions
Ran out of time last night, but here are thoughts / questions. Please weigh in if you are able:
Dr. Shain had an interest in understanding if my brother's anemia (RBC) was historically on the low side. From the 2012 lab results, it appears his labs from 2012 indicate he was then. Does this suggest that his slightly lower numbers may not necessarily fulfill the "A" of CRAB?
Lab results of December 29, 2014 give B2M of 2.97 mg/L, which is elevated but still below 3.5 mg/L I think this means he is very early active or perhap smoldering. I understand we are still missing labs so this is my thinking, not clinical fact. Make any sense?
I've read and will repeat until the sFLC makes some sense to me. Seems to be eluding me ... how to look at his lab results.
The only thing I can take away from the bone marrow biopsy - I think - is that he has>= 10% plasma cell involvement. I don't understand why it is > or = rather thought it would be more exact or in a set range. Still very much lower than the 60% as part of the qualifying for active multiple myeloma. His result looks like very early multiple myeloma - make sense?
We won't be able to have an MRI done before his appointment on Monday. I am so relieved to know I will understand some of what the doctor says to us. And it is directly because of all I've read and learned from this amazing, generous, and compassionate community.
Thanks.
Dr. Shain had an interest in understanding if my brother's anemia (RBC) was historically on the low side. From the 2012 lab results, it appears his labs from 2012 indicate he was then. Does this suggest that his slightly lower numbers may not necessarily fulfill the "A" of CRAB?
Lab results of December 29, 2014 give B2M of 2.97 mg/L, which is elevated but still below 3.5 mg/L I think this means he is very early active or perhap smoldering. I understand we are still missing labs so this is my thinking, not clinical fact. Make any sense?
I've read and will repeat until the sFLC makes some sense to me. Seems to be eluding me ... how to look at his lab results.
The only thing I can take away from the bone marrow biopsy - I think - is that he has>= 10% plasma cell involvement. I don't understand why it is > or = rather thought it would be more exact or in a set range. Still very much lower than the 60% as part of the qualifying for active multiple myeloma. His result looks like very early multiple myeloma - make sense?
We won't be able to have an MRI done before his appointment on Monday. I am so relieved to know I will understand some of what the doctor says to us. And it is directly because of all I've read and learned from this amazing, generous, and compassionate community.
Thanks.
-
greenrobin - Who do you know with myeloma?: My brother
- When were you/they diagnosed?: 12/2014
- Age at diagnosis: 54
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