[LTGates90]

Can you have multiple myeloma with polyclonal gammopathy?

by LTGates90 on Mon Feb 27, 2017 3:00 pm

Hi,

I have been dealing with unexplained bone lesions for a few years. The doctors started investigating multiple myeloma. They are almost certain my first lesion (in my spine) was a plasmacytoma. I have another lesion in my sternum.

Blood work and biopsy showed:

Elevated plasma cells in the biopsy (polyclonal)
High total serum protein (normal albumin, high gamma antibody-polyclonal)
I also have high mean platelet volume with normal platelet count.
Autoimmunity markers are all negative.

My question is:

I am young (26) and instead of monoclonal, I have polyclonal gammopathy with multiple bone lesions. Can anything else explain these symptoms?

[Multibilly]

Re: Can you have multiple myeloma with polyclonal gammopathy

by Multibilly on Mon Feb 27, 2017 8:19 pm

Hi LTGates90,

From what you describe, it doesn't sound like multiple myeloma. By definition, multiple myeloma is a monoclonal gammopathy. Have the doctors ruled out all forms of lymphoma and leukemia?

[LTGates90]

Re: Can you have multiple myeloma with polyclonal gammopathy

by LTGates90 on Fri Mar 03, 2017 1:06 pm

Hi Multbilly,

I realized that I mistook not having an M-spike as having polyclonal gammopathy. My physician let me know that I do not have an M-spike, but I have an elevated kappa free light chain level and an elevated kappa-lambda ratio. I am seeing a hematologist Tuesday. I am concerned about these results in conjunction with my current sternal hot spot and previous plasmacytoma.

I have not been tested for lymphoma/leukemia. I don't have any lymphadenopathy, and I haven't heard as much about bone lesions in those blood disorders.

I had a plasmacytoma removed from my thoracic spine in November. In January, I had a follow up bone scan that showed signal in my sternum (where I am experiencing severe pain). MRI and CT confirmed abnormal signal within the body and manubrium of my sternum.

My rheumatologist ordered blood work:

CBC was quite normal except for larger than normal platelets.

My SEP demonstrated higher than normal total protein (8.5 g/L) and higher than normal kappa light chain (23 mg/dL) and only slightly elevated ratio (1.6). Calcium, GFR, and creatinine are in normal limits. She is concerned about the kappa free light chain elevation and referred me to a hematologist-oncologist.

Any more information, advice, opinions are greatly appreciated.

[Multibilly]

Re: Can you have multiple myeloma with polyclonal gammopathy

by Multibilly on Sat Mar 04, 2017 11:50 am

You really need to be looking at the results of your serum immunofixation test to see if the free light chains are monoclonal or not. Given your bone marrow biopsy showed only polyclonal proteins and you posted these serum results earlier (High total serum protein (normal albumin, high gamma antibody-polyclonal), it seems like your elevated kappa is polyclonal in nature. Also, your free light chain ratio is not technically out of range. Under the circumstances, your hematologist might order a 24 hour urine protein electrophoresis to see if you have any monoclonal free light chains (aka Bence Jones proteins) in your urine.

You may want to look at this table to better understand what the various mixes of serum kappa, lambda and FLC ratios mean:

https://myelomabeacon.org/forum/kappa-lambda-free-light-chains-t5452.html#p31873