[mishmosh]

Confused about test results - appreciate input

by mishmosh on Tue Nov 19, 2013 9:58 am

I had an irregular urine test which led to more and more tests (urine and blood), then to a hematologist suspecting multiple myeloma, and a different hematologist suspecting MGUS.
I am due to do a bone marrow biopsy next week, but would like to get a better understanding of my test results before visiting the hospital next week.

I am trying to understand my various results, and am getting more and more confused all the time!

My immunofixation test shows IGA lambda.

My IGA blood level is currently about 400mg/dl, which is just slightly out of the normal range. It has hovered about this level since January 2006. My IGM and IGG have been in the normal range since 2006 and still are.

My lambda FLC is 215mg/l. This has only been measured since September this year. In September it was 204. In October it went down(!!??) to 189. And in November it is 215.

My FLC ratio is 0.05. Totally abnormal.
My Bence Jones test was positive. Is this a Not good news I understand.

CRAB levels are all ok. Creatinine clearance test slightly out of the range (high). Protein / Creatinine (U) was totally off the scale - 2640mg/g on a scale of 0-200 mg/g.
My only symptoms are a 2 year long cough I cannot shake and a years-long nearly daily rash that spontaneously erupts and disappears.

Here are my questions:
Are the lambda FLC changes significant (the normal range is 5.71-26.3 and mine have increased 25 units in a month, compared to a decrease of 11 units the previous month.)
Is my MGUS/multiple myeloma type IGA Lambda (as per immunofixation test)?
What is my M spike value? i.e. is it my IGA value? Or is it my lambda FLC value? (Or a combination?)
Does a lambda FLC count as a monoclonal protein?
Does the FLC show a high risk of progression(being totally abnormal)?
Does the Bence-Jones protein show a high risk of progression?
Since my IGA,IGM,IGG have been fairly stable since 2006, might this be light-chain MGUS/multiple myeloma since the lambda FLC is the abnormal result?
Is the Protein / Creatinine result merely a ratio measurement of the IGA/IGM/IGG/lambda FLC versus the creatinine level?

I know there are lots and lots of questions! I would appreciate the effort/thought anyone could provide into providing answers. THANKS!!

[Beacon Staff]

Re: Confused about test results - appreciate input

by Beacon Staff on Tue Nov 19, 2013 11:17 am

Hi MishMosh,

Just so you're aware of it, you can find all the Beacon's news articles with information related to MGUS here:

https://myelomabeacon.org/tag/mgus/

Included in those articles is one from a few years back (link) that discusses the consensus at the time about risk factors for progression from MGUS to symptomatic myeloma.

Some of the more recent articles at The Beacon (listed in the first link above) discuss new research on the subject.

There are also a number of abstracts being presented at the ASH meeting related to MGUS. Many of them can be found at this link:

https://myelomabeacon.org/tag/ash-2013-mgus/

Included in the abstracts is one that discusses a major Spanish study looking at FLC tests and what they may mean about the risk of progression to symptomatic myeloma:

https://myelomabeacon.org/resources/mtgs/ash2013/abs/3132/

Finally, there have been many discussions about how to interpret M-spike results here at the forum, including what exactly an M-spike is. You can find all those discussions by simply typing "spike" into the search box above, which will take you to this list of discussion threads.

We realize that these links won't provide answers to all your questions, but we hope they're a good start.

Good luck!

[Dr. Jason Valent]

Re: Confused about test results - appreciate input

by Dr. Jason Valent on Tue Nov 19, 2013 6:18 pm

1. The lambda level is abnormal. But the changes seen over the last few months are not significant. Those are essentially all the same reading.

2. Yes. You have an IgA lambda monoclonal protein. You have 3 means by which to follow the abnormal plasma cell population in the bone marrow. With the M-protein, the total IgA level, and with the free lambda light chain. In your case the M-protein and the free lambda light chain are the monoclonal proteins (although they can be considered one in the same).

3. Absolute value of the free lambda light chain probably does not indicate a high risk of progression (although IgA monoclonal proteins have a slightly higher risk of progression). Other finding that predicts for higher risk of progression are % of bone marrow plasma cells over 10%.

4. The protein to creatinine ratio needs discussion with your doctors. This is a surrogate estimate of the amount of protein excreted from kidney in 24 hours. You need a 24 hour urine collection for protein electrophoresis. You need to know how much of this protein is the Monoclonal protein and how much is Albumin (healthy protein in blood). This is particularly important. If you are spilling Albumin in the urine without another cause for this (diabetes/high blood pressure) then one has to consider the monoclonal protein (or light chain in particular) is potentially doing damage to the kidney. A kidney biopsy may be necessary to evaluate this particularly if you do not have another reason to start treatment for myeloma (CRAB criteria). You can still have a normal Creatinine (which is the renal assessment in cRab criteria) and have damage from the monoclonal protein which then needs to be treated as if you have myeloma.

I hope this made sense.

[mishmosh]

Re: Confused about test results - appreciate input

by mishmosh on Wed Nov 20, 2013 6:17 am

Thank you for your in-depth reply Jason.
In my month or so of in-depth reading on MGUS/myeloma, I didn't explore the proteinuria very much, focusing on M-proteins and FLCs.

Regarding the protein to creatinine ratio - I already did two 24 hour urine tests. Here are the results:
(not 24 hour test)
25/6/13 Protein / Creatinine (U) 2640mg/g (normal 0-200)
25/6/13 Albumin/creatinine ratio >300 mg/g (but no exact result for this test)

24 hour test)
Protein (U)/24 hr
11-8-2013 110mg/24hours (normal range 0-150)
20-10-2013 50mg/24hours (normal range 0-150)

I think that my doctor said these levels were normal.

I see that I worded a question wrongly. Instead of saying 'Does the FLC show a high risk of progression(being totally abnormal)?' I meant to say:
Does the FLC RATIO show a high risk of progression(being totally abnormal)?
Everything I have read so far says that an abnormal ratio does have a higher risk factor.

[mishmosh]

Re: Confused about test results - appreciate input

by mishmosh on Wed Nov 20, 2013 6:40 am

Still trying to figure something out!
I've been looking at the summary table (which I think is quite good!) at http://asheducationbook.hematologylibrary.org/content/2012/1/595/T1.large.jpg

When it says, under light-chain MGUS, 'no ig heavy chain expression on immunofixation' could that include levels of IGA/IGG/IGM that are in the normal range'?

Because I don't understand if I have IGA lambda MGUS/multiple myeloma or light-chain MGUS/multiple myeloma since my IGA,IGG,IGM are pretty normal but the FLC ratio is totally abnormal (which would be normal in light-chain MGUS/multiple myeloma)

[mishmosh]

Re: Confused about test results - appreciate input

by mishmosh on Sat Jan 25, 2014 1:39 am

Hi, immunofixation showed iga lambda, but my iga serum levels are normal, while my lambda are very far from being normal.

I am newly diagnosed smoldering and no treatment done yet, but am trying to understand my situation better.