Hello,
My bone marrow biopsy 2 years ago showed normal cytogenetics. The last one I had in November 2015 showed t(11:14), monosomy 13 and CD56+.
Does a change in cytogenetics indicate progression in smoldering multiple myeloma?
There is a lot of discussion surrounding risk stratification with translocations but nothing about normal to abnormal.
Thanks
J
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jhorner - Name: Magpie
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2013
- Age at diagnosis: 49
Re: Cytogenetics changes & progression in smoldering myeloma
Jhorner,
If your question is whether adverse cytogenetic changes indicate progression to symptomatic multiple myeloma, I don't believe that is the case. Progression from smoldering multiple myeloma to symptomatic multiple myeloma is still defined by meeting one or more of the "CRAB" criteria and, at the doctor's discretion, the new "SLiM" criteria.
Now having said that, I would tend to GUESS that if you have new clonal lines that are evolving in your body, that one or more of your serum or urine markers (M-spike, etc) may also be trending upwards simply because you will have more clonal lines that are adding to your total monoclonal protein population.
In turn, due to the additional disease burden of these new clonal lines (again, this is just a guess that they are adding to your overall disease burden) and the higher risk nature of these recent cytogenetic changes, it is then statistically more likely that you will hit one of the SLiMCRAB criteria sooner.
But also keep in mind that your specific cytogenetic changes are not that worrisome and are considered "standard" risk-of-progression features (as opposed to your earlier "low risk" status). See Table 2 in the following article:
"Great article - cytogenetics (chromosomal abnormalities)" (started Nov 3, 2015)
If your question is whether adverse cytogenetic changes indicate progression to symptomatic multiple myeloma, I don't believe that is the case. Progression from smoldering multiple myeloma to symptomatic multiple myeloma is still defined by meeting one or more of the "CRAB" criteria and, at the doctor's discretion, the new "SLiM" criteria.
Now having said that, I would tend to GUESS that if you have new clonal lines that are evolving in your body, that one or more of your serum or urine markers (M-spike, etc) may also be trending upwards simply because you will have more clonal lines that are adding to your total monoclonal protein population.
In turn, due to the additional disease burden of these new clonal lines (again, this is just a guess that they are adding to your overall disease burden) and the higher risk nature of these recent cytogenetic changes, it is then statistically more likely that you will hit one of the SLiMCRAB criteria sooner.
But also keep in mind that your specific cytogenetic changes are not that worrisome and are considered "standard" risk-of-progression features (as opposed to your earlier "low risk" status). See Table 2 in the following article:
"Great article - cytogenetics (chromosomal abnormalities)" (started Nov 3, 2015)
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Cytogenetics changes & progression in smoldering myeloma
Multibilly,
Great info that you provided to JHorner. Very similar to what you provided to me 2 years ago when testing tied to my 2nd bone marrow biopsy indicated clonal abnormalities which I didn't expect, as an earlier bone marrow biopsy resulted in normal results. Thanks for keeping everyone informed!
JHorner,
As I alluded to above, cytogenetic testing tied to my initial 2013 bone marrow biopsy did not include any clonal abnormalities, while my 2014 results did indicate several (too many to list here - I will paste them at the bottom of this message for reference).
Two years later, I have not progressed to active multiple myeloma and feel I'm far from it, but my M-spike has continued to rise (now more than 2x the value at the time of my 2014 bone marrow biopsy), as has my free light chain ratio and now Bence Jones protein is present via UPEP. So I guess my case is clearly evolving, but hopefully very slowly until a smoldering multiple myeloma vaccine / cure is avail prior to any active multiple myeloma signs.
Just as Multibilly suggested, a change in cytogenetic profiling may coincide with an increasing tumor burden (M spike / bone marrow plasma cell percentage), which was exactly my case comparing 2013 and 2014 results:
2013 Bone Marrow Biopsy - normal cytogenetic profile
I'll have a bone marrow biopsy in the next 1 - 2 months and it will be interesting to see if there's any change in cytogenetic profiling as well as percent of plasma cells and percent of neoplastic plasma cells (in 2014, 91% of plasma cells were abnormal - where 95% and higher represent high-risk smoldering multiple myeloma).
You said that you tested positiive for CD56+ - My profile included several abnormal results including CD54 negative (complete 2014 results below as FYI) . My 2013 results were much more basic and I was a little surprised to find so many changes in the 2014 results less than 1 year later. It was a little easier keeping up with my early MGUS results.
Specimen BM right
Markers on: PCs
Interpretation: Aberrant plasma cells detected, 91% of total plasma cells, consistent with plasma cell neoplasm
Aberrant PCs CD38+, CD138+, CD19(partial), CD20(+), CD28(-), CD56(-), CD117(+), cyto-Kappa(+), cyto-Lambda(-).
Great info that you provided to JHorner. Very similar to what you provided to me 2 years ago when testing tied to my 2nd bone marrow biopsy indicated clonal abnormalities which I didn't expect, as an earlier bone marrow biopsy resulted in normal results. Thanks for keeping everyone informed!
JHorner,
As I alluded to above, cytogenetic testing tied to my initial 2013 bone marrow biopsy did not include any clonal abnormalities, while my 2014 results did indicate several (too many to list here - I will paste them at the bottom of this message for reference).
Two years later, I have not progressed to active multiple myeloma and feel I'm far from it, but my M-spike has continued to rise (now more than 2x the value at the time of my 2014 bone marrow biopsy), as has my free light chain ratio and now Bence Jones protein is present via UPEP. So I guess my case is clearly evolving, but hopefully very slowly until a smoldering multiple myeloma vaccine / cure is avail prior to any active multiple myeloma signs.
Just as Multibilly suggested, a change in cytogenetic profiling may coincide with an increasing tumor burden (M spike / bone marrow plasma cell percentage), which was exactly my case comparing 2013 and 2014 results:
2013 Bone Marrow Biopsy - normal cytogenetic profile
- IgG kappa M-spike 0.375 g/dL, no Bence Jones protein on UPEP
- 5% bone marrow plasma cell percentage
- M-spike 0.425 g/dL, slightly increased free light chain ratio over 2013, clear Bence Jones protein on UPEP
- Thankfully, no high-risk mutations were found
- 10% bone marrow plasma cell percentage (2x the 2013 result and possibly why aberrant cells were detected this time).
I'll have a bone marrow biopsy in the next 1 - 2 months and it will be interesting to see if there's any change in cytogenetic profiling as well as percent of plasma cells and percent of neoplastic plasma cells (in 2014, 91% of plasma cells were abnormal - where 95% and higher represent high-risk smoldering multiple myeloma).
You said that you tested positiive for CD56+ - My profile included several abnormal results including CD54 negative (complete 2014 results below as FYI) . My 2013 results were much more basic and I was a little surprised to find so many changes in the 2014 results less than 1 year later. It was a little easier keeping up with my early MGUS results.
Specimen BM right
Markers on: PCs
Interpretation: Aberrant plasma cells detected, 91% of total plasma cells, consistent with plasma cell neoplasm
Aberrant PCs CD38+, CD138+, CD19(partial), CD20(+), CD28(-), CD56(-), CD117(+), cyto-Kappa(+), cyto-Lambda(-).
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pinball - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2010 MGUS, 2014 Smoldering
- Age at diagnosis: 39
Re: Cytogenetics changes & progression in smoldering myeloma
Thank you very much, Multibilly and Pinball, for your thoughtful replies.
Pinball,
Your disease sounds very much like mine did in the MGUS phase. I was initially IgG kappa with IgM suppression and 0.5 g/dl of M-protein. In 2011 I had no M-spike, 2013 biclonal switching to IgG lambda, 1 g/dl and supressed IgA and IgM.
I never had a bone marrow biopsy as an MGUS patient, but my first bone marrow biopsy as a smoldering patient was 10-15% and my second was 20-30%. My oncologist said that it is still considered low burden and bone marrow is patchy, but since my lambda light chains continue to go down and the lambda plasma cells in the bone marrow go up, I am likely oligosecratory and will have more frequent bone marrow biopsies to watch the disease, so I'll get to watch the cytogenetics morph ... yeah! We thought we could use light chains to measure disease burden, since the M-spike was unreliable due to having both IgG kappa and IgG lambda, but the light chains are almost non existent in the free light chain assay.
It truly is a heterogeneous disease so it is always interesting when you see some similarities with another smoldering myeloma patient.
Good luck and thank you for the insight!
J
Pinball,
Your disease sounds very much like mine did in the MGUS phase. I was initially IgG kappa with IgM suppression and 0.5 g/dl of M-protein. In 2011 I had no M-spike, 2013 biclonal switching to IgG lambda, 1 g/dl and supressed IgA and IgM.
I never had a bone marrow biopsy as an MGUS patient, but my first bone marrow biopsy as a smoldering patient was 10-15% and my second was 20-30%. My oncologist said that it is still considered low burden and bone marrow is patchy, but since my lambda light chains continue to go down and the lambda plasma cells in the bone marrow go up, I am likely oligosecratory and will have more frequent bone marrow biopsies to watch the disease, so I'll get to watch the cytogenetics morph ... yeah! We thought we could use light chains to measure disease burden, since the M-spike was unreliable due to having both IgG kappa and IgG lambda, but the light chains are almost non existent in the free light chain assay.
It truly is a heterogeneous disease so it is always interesting when you see some similarities with another smoldering myeloma patient.
Good luck and thank you for the insight!
J
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jhorner - Name: Magpie
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2013
- Age at diagnosis: 49
4 posts
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